Priority 7 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: Which are the most important factors which decide whether a patient over 50 with an upper limb fracture is treated with or without surgery? (JLA PSP Priority 7)
Overall ranking	7
JLA question ID	0093/7
Explanatory note	An upper limb fracture can be managed with or without an operation. There are many factors that can help doctors and patients decide what is best for them. This question looks to determine what are the most important factors that influence whether we operate or not on an upper limb fracture. Uncertainties focused on specific upper limb fractures such as proximal humerus, clavicles and wrists as well as asking about specific factors such as preventing complications; allowing earlier mobilisation; the fracture pattern and co-morbidities.
Evidence	National Institute for Health and Care Excellence. Fractures (non-complex): assessment and management (NG38). London: NICE, 2016. The British Society of Surgery for the Hand. Best Practice for management of Distal Radius Fractures (DRFs). BSSH, 2018 For full details of the evidence checked, please see the spreadsheet of data held on the JLA website.
Health Research Classification System category	Injuries and Accidents

Extra information provided by this PSP
Original uncertainty examples	Could an upper limb fracture lead to other musculoskeletal dysfunction/ pain if not managed correctly? ~ Likelihood of OA changes post Trauma in the shoulder, same with distal radius and what thus means for functional outcome. ~ What percentage of isolated ulna shaft fractures go onto a non-union? ~ Orthopaedics agreed that the wrist had not healed straight; that there was an unacceptable loss of function and pain was from the ulna impingement. 18 months later I had a radial osteotomy to regain function in my wrist and hand, which was very effective. ~ How does an upper limb fracture affect mobility? ~ What are the options of treatment? ~ What is the best way to treat a volar displaced distal radius fracture? ~ What is the best treatment for isolated fractures of the ulna shaft - no splint, above elbow cast or below elbow cast?
Submitted by	84 x Healthcare Professionals, 78 x Patients, 18 x Carers/relatives, 1 Research Nurse, 4 x Not stated

Extra information provided by this PSP

Original uncertainty examples

Could an upper limb fracture lead to other musculoskeletal dysfunction/ pain if not managed correctly? ~ Likelihood of OA changes post Trauma in the shoulder, same with distal radius and what thus means for functional outcome. ~ What percentage of isolated ulna shaft fractures go onto a non-union? ~ Orthopaedics agreed that the wrist had not healed straight; that there was an unacceptable loss of function and pain was from the ulna impingement. 18 months later I had a radial osteotomy to regain function in my wrist and hand, which was very effective. ~ How does an upper limb fracture affect mobility? ~ What are the options of treatment? ~ What is the best way to treat a volar displaced distal radius fracture? ~ What is the best treatment for isolated fractures of the ulna shaft - no splint, above elbow cast or below elbow cast?

Submitted by

84 x Healthcare Professionals, 78 x Patients, 18 x Carers/relatives, 1 Research Nurse, 4 x Not stated

PSP information
PSP unique ID	0093
PSP name	Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP.	50 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	3 December 2018