Priority 8 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: What is the best surgical management for an upper limb fracture in people over 50? (e.g. incision, technique, metalwork, technology) (JLA PSP Priority 8)
Overall ranking	8
JLA question ID	0093/8
Explanatory note	Some patients who have broken their arm will require an operation to help the bone heal. This question looks to determine what is the ideal way that we operate on specific upper limb fractures to optimise recovery and prevent complications, such as long-term pain. Uncertainties focused on the method of incision and surgery; the type of metalwork used; and whether we can use technology to improve surgical techniques (such as using 3D printing or virtual surgery).
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	Is IM nailing for 3 and 4 part fractures of shoulder Better than plating ? as this can be done through less surgical dissection? ~ What is the role of type of humeral implant in optimising results in hemiarthroplasty for proximal humeral fractures? ~ Are there alternatives to hook plate for distal clavicle fractures?
Submitted by	11 x Healthcare Professionals, 4 x Patients, 3 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