{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:50:54Z","timestamp":1792687854604,"version":"4.5.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11,6]]},"abstract":"<jats:p>The treatment of proximal humeral fractures is controversial, and operative treatment is increasing despite sparse evidence to support any surgical method over another. We present the 5-year results of the DelPhi (Delta-PHILOS) trial, in which the hypothesis was that reverse total shoulder arthroplasty (RTSA) yields better clinical results compared with open reduction and internal fixation (ORIF). The DelPhi trial was a multicenter single-blinded randomized controlled trial comparing RTSA versus ORIF for the treatment of displaced AO\/OTA type-B2 and C2 proximal humeral fractures in patients 65 to 85 years of age. One hundred and twenty-four patients were allocated to RTSA (64 patients) or ORIF (60 patients). The primary outcome was the Constant score, and secondary outcomes included the Oxford Shoulder Score, radiographic measurements, and quality of life. The results were reported as the mean difference between the groups, with the 95% confidence interval (CI). The mean age was 75 years, and 90% of the patients were female. Overall, 65 of the 124 patients were available at a minimum of 5 years. The mean Constant score was 71.7 (95% CI, 67.1 to 76.3) for the RTSA group, compared with 58.3 (95% CI, 50.6 to 65.9) for the ORIF group, representing a significant difference of 13.4 (95% CI, 5.2 to 21.7) in favor of RTSA (p = 0.002). Among patients with type-C2 fractures, the mean Constant score was 73.3 (95% CI, 67.5 to 79.2) for the RTSA group and 56.0 (95% CI, 47.4 to 64.7) for the ORIF group, representing a significant difference of 17.3 (95% CI, 7.5 to 27.0) in favor of RTSA (p = 0.001). Patients with type-B2 fractures demonstrated a nonsignificant difference of 8.1 (95% CI, \u22127.3 to 23.3) in favor of RTSA (p = 0.29). Patients 65 to 74 years of age showed a significant mean difference of 15.7 (95% CI, 4.9 to 26.7) in favor of RTSA (p = 0.006), whereas patients 75 to 85 years of age showed a nonsignificant difference of 10.8 (95% CI, \u22123.0 to 24.6) in favor of RTSA. In the present study, RTSA was superior to plate fixation for displaced AO\/OTA type-B2 and C2 fractures in elderly patients at 5 years. Patients 65 to 74 years of age and patients with type-C2 fractures benefited the most.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.01431","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T14:10:21Z","timestamp":1726841421000},"page":"1945-1956","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Reverse Shoulder Arthroplasty Is Superior to Plate Fixation for Displaced Proximal Humeral Fractures in the Elderly"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3258-3365","authenticated-orcid":false,"given":"Alexander Nilsskog","family":"Fraser","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"},{"name":"Department of Orthopaedic Surgery, Diakonhjemmet Hospital, Oslo, Norway"},{"name":"Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2575-6819","authenticated-orcid":false,"given":"Tone Mehlum","family":"Wagle","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2227-0362","authenticated-orcid":false,"given":"Anna Cecilia","family":"Karlberg","sequence":"additional","affiliation":[{"name":"Division of Radiology and Nuclear Medicine, Department of Musculoskeletal Radiology, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9002-1213","authenticated-orcid":false,"given":"Jan Erik","family":"Madsen","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Mellberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, Gr\u00e5lum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0087-5598","authenticated-orcid":false,"given":"Tom","family":"Lian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vestre Viken Hospital Trust, B\u00e6rum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2569-1831","authenticated-orcid":false,"given":"Simone","family":"Mader","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, F\u00f8rde Hospital Trust, F\u00f8rde, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3022-7858","authenticated-orcid":false,"given":"Lars","family":"Eilertsen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9227-2959","authenticated-orcid":false,"given":"Hilde","family":"Apold","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Telemark Hospital Trust, Skien, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3853-5791","authenticated-orcid":false,"given":"Leif B\u00f8rge","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vestfold Hospital Trust, T\u00f8nsberg, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1678-7309","authenticated-orcid":false,"given":"Are Hugo","family":"Pripp","sequence":"additional","affiliation":[{"name":"Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4995-9891","authenticated-orcid":false,"given":"Tore","family":"Fjalestad","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"issue":"4","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/000164701753542023","article-title":"The epidemiology of proximal humeral fractures","volume":"72","author":"Court-Brown","year":"2001","journal-title":"Acta Orthop 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