{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:42:29Z","timestamp":1787755349682,"version":"build-2784847793"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Humeral shaft fractures commonly affect working-age adults and can lead to prolonged work absence and substantial economic burden. Although surgical fixation and functional bracing offer comparable functional outcomes, their relative cost-effectiveness remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a prespecified economic evaluation alongside a multicenter, superiority, randomized clinical trial at 2 Finnish university hospitals between 2012 and 2018. Eighty-two adults (mean age, 48.9 years; 38 women) with displaced, closed humeral shaft fractures were randomly assigned to surgical fixation (n = 38) or functional bracing (n = 44) and followed for 2 years. The primary outcome was the incremental net monetary benefit (INMB) based on quality-adjusted life years (QALYs) measured with the 15-dimensional (15D) instrument, analyzed from both societal and health-care perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From a societal perspective, surgical treatment was both more effective and less costly than bracing. The mean total cost per patient was \u20ac23,680 for surgery and \u20ac30,389 for bracing, yielding an INMB of \u20ac9,423 (95% confidence interval [CI], \u20ac4,139 to \u20ac14,609). Cost-effectiveness acceptability curves showed that surgery was highly likely to be cost-effective across all willingness-to-pay thresholds up to \u20ac120,000 per QALY. The cumulative QALYs from 6 weeks to 2 years post-injury were 1.776 (95% CI, 1.725 to 1.827) for surgery and 1.705 (95% CI, 1.641 to 1.769) for bracing, corresponding to a QALY difference of 0.071 (95% CI, 0.012 to 0.130) in favor of surgery. From the health-care perspective, functional bracing was less costly (\u20ac4,904 versus \u20ac10,967) and therefore more cost-effective, with an INMB of \u2212\u20ac4,087 (95% CI, \u2212\u20ac5,215 to \u2212\u20ac3,054). When considering only direct medical costs, surgery was unlikely to be cost-effective at thresholds below \u20ac80,000 per QALY, reaching a 75% probability of cost-effectiveness only at \u20ac120,000 per QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Surgery is cost-effective when societal costs are considered. Functional bracing remains a reasonable option, particularly for patients less affected by time away from work. Shared decision-making should incorporate both economic and individual patient factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Economic\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.25.00867","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T19:00:13Z","timestamp":1771959613000},"page":"992-1001","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Cost-Effectiveness of Surgery Versus Functional Bracing for Humeral Shaft Fractures in Adults"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8383-7479","authenticated-orcid":false,"given":"Cyrill","family":"Suter","sequence":"first","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9658-8571","authenticated-orcid":false,"given":"Thomas","family":"Ibounig","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6903-6461","authenticated-orcid":false,"given":"Aleksi","family":"Reito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Tampere University Hospital, University of Tampere, Wellbeing Services County of Pirkanmaa, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3656-4601","authenticated-orcid":false,"given":"Henrik","family":"Mattila","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8267-8653","authenticated-orcid":false,"given":"Bakir O.","family":"Sumrein","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Tampere University Hospital, University of Tampere, Wellbeing Services County of Pirkanmaa, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3125-0171","authenticated-orcid":false,"given":"Antti P.","family":"Launonen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Tampere University Hospital, University of Tampere, Wellbeing Services County of Pirkanmaa, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Paavola","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3713-956X","authenticated-orcid":false,"given":"Teppo L.N.","family":"J\u00e4rvinen","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6755-2983","authenticated-orcid":false,"given":"Simo","family":"Taimela","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4154-8462","authenticated-orcid":false,"given":"Lasse","family":"R\u00e4m\u00f6","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the FISH Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"issue":"8","key":"bib1-20260730","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A 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