Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Stig Brorson, University of Copenhagen,
- Second opponent: Senior consultant Randi Margrete Hole, Haukeland University Hospital,
- Third member and chair of the evaluation committee: Professor Wender Figved, University of Oslo
Chair of the Defence
Associate Professor Harald Hrubos-Strøm, University of Oslo
Principal Supervisor
Professor Per-Henrik Randsborg, University of Oslo
Summary
This thesis concerns the field of orthopaedic traumatology and investigates surgical treatment of complex proximal humerus fractures (PHFs). The main research question was whether locking plates or locking nails provide better outcomes when performing osteosynthesis on displaced 3- and 4-part PHFs.
The work includes a retrospective study and a prospective randomized controlled trial (RCT). The retrospective study analysed surgically treated PHFs at Akershus University Hospital over four years, focusing on fracture patterns, complications, and patient-reported outcomes. It found that calcar screws and precise fracture alignment significantly reduced fixation failure.
The RCT compared locking plates and locking nails in a semi-blinded study-design, using a patient reported outcome (the DASH score) as the primary endpoint. Both implants yielded similar functional outcomes, but nails were associated with more complications and reoperations. A health-economic analysis showed that locking plates were more cost-effective, even when excluding reoperation costs. However, these findings are context-dependent and may not be directly transferable to other healthcare systems with different cost structures.
The thesis concludes that locking plates should be preferred over nails when performing osteosynthesis on complex PHFs. It also highlights the importance of surgical technique and implant selection in improving patient outcomes and optimizing healthcare resources.
Additional information
Contact the research support staff.