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Concerns about the evidence in relation to implementation of the ProFHER trial
  1. Helen Handoll1,
  2. Stephen Brealey2,
  3. Amar Rangan2
  1. 1 School of Health & Life Sciences, Teesside University, Middlesbrough, UK
  2. 2 Department of Health Sciences, University of York, York, UK
  1. Correspondence to Dr Helen Handoll, Teesside University, Middlesbrough TS1 3BX, UK; h.handoll{at}

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As members of the Proximal Fracture of the Humerus: Evaluation by Randomisation (ProFHER) trial management team, we were keen to read the paper by Reeves et al.1 However, we have the following reservations in relation to the accuracy of the data that call into question the findings and conclusion of the report in relation to our trial:

1. Substantial underestimate of baseline numbers: the authors state that ‘in the years 2011–17 there were 13 628 admissions with patients aged 16+ years with a fracture of the upper humerus’. This is a substantial underestimate. Inspection of the diagnosis table (primary diagnosis S42.2) for 2016–17 (accessed via: shows there were 18 172 episodes and 12 823 admissions for this 1-year period. As expected, given that these fractures occur mainly in older adults, the majority of these applied to adults (312 episodes occurred in children aged <16 years). Although still a major underestimate, inexplicably the number of procedures on which the authors’ analyses are based is 22 163 as detailed in table …

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  • Contributors All authors contributed to the writing of the letter and revising the letter in response to editorial feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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