BACKGROUND: The aim of the study was to report the 2-year outcome after a displaced 3-part fracture of the proximal humerus in elderly patients randomized to treatment with a locking plate or nonoperative treatment. PATIENTS AND METHODS: We included 60 patients, mean age 74 years (range 56 to 92), 81% being women. The main outcome measures were the Constant and Disabilities of the Arm, Shoulder and Hand (DASH) scores and the health-related quality of life (HRQoL) according to the EQ-5D. RESULTS: At the final 2-year follow-up, the results for range of motion (ROM), function and HRQoL were all in favor of the locking plate group. The mean flexion in the locking plate group was 120 degrees compared to 111 degrees in the nonoperative group (p = 0.36) and the mean abduction was 114 degrees compared to 106 degrees (p = 0.28). The corresponding values for the Constant score were 61 versus 58 (p = 0.64), for DASH 26 versus 35 (p = 0.19), and the mean EQ-5D (index) score was 0.70 compared to 0.59 (p = 0.26). In spite of good primary reduction in 86% of the fractures in the locking plate group, 13% of the patients had a fracture complication requiring a major reoperation and 17% had a minor reoperation. CONCLUSION: The results of our study indicate an advantage in functional outcome and HRQoL in favor of the locking plate compared to nonoperative treatment in elderly patients with a displaced 3-part fracture of the proximal humerus, but at the cost of additional surgery in 30% of the patients. LEVEL OF EVIDENCE: Level I, randomized controlled trial, treatment study.

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