Ho, ho, ho! Gather around, my dear friends, for I have a tale to tell, not of reindeer and elves, but of a quest in the medical realm—a quest to conquer the frosty challenge of Proximal Humeral Fractures (PHFs), a common mishap among the older elves in our midst. In the land of science, much like in the North Pole, the pursuit of the perfect solution is ongoing, with many a clinical trial sleighing through the snow to find the best therapeutic approach.

In the frosty month of December 2022, our story takes us on a sleigh ride through the vast expanse of Clinicaltrials.gov, where researchers, much like busy elves, screened interventional clinical trials related to PHFs. They checked their list not once but twice, noting the duration, status, intervention, and other characteristics of each trial, much like I check my list of who’s naughty or nice. They then ventured through the snowy fields of PubMed/Medline, guided by the bright star of each trial’s registry number, in search of publications.

At the end of their journey, they found a sack full of 64 trials. The majority of these trials, much like the most dedicated elves, were completed (36%), embarked on their mission without a specific phase defined by the Food and Drug Administration (67%), and were randomized (81%), spreading their interventions across the globe with a single facility’s focus (72%). They followed a parallel assignment intervention model (80%) and often chose an open-label approach (45%), much like I choose to deliver presents openly and with joy. However, only 11 trials had found their way into the published world, making the publication rate a mere 17%, a number that even the Grinch would find low.

The average enrollment was 86 participants, with a mean trial duration of 51.4 months, longer than the wait for next Christmas! The majority of these trials took place in the lands of Europe/UK/Russia/Turkey (70%), with most sleighs taking off after 2010 (87.5%). The most common intervention was procedure-related (55%), aiming to restore the joy of mobility, and disability/function was the most common primary outcome assessed (61%), hoping to bring the gift of movement back to many.

Alas, the low publication rate and the flurry of trials conducted after 2010 highlight the urgent need for these findings to be wrapped up and presented under the tree of medical knowledge. The story also whispers a wish for future trials to involve more than one institution and to embrace blinding, to ensure that the results are as reliable as Rudolph leading the sleigh on a foggy Christmas Eve. And so, my friends, our tale ends, but the quest continues, with hopes high that the perfect therapeutic protocol for PHFs will soon be found, wrapped with a bow, and delivered to all in need.

And with that, I must return to the North Pole, for there are toys to be made and reindeer to be fed. But fear not, for the spirit of discovery lives on, in the hearts of those who seek to heal and help. Merry Christmas to all, and to all a good night!