Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017

• Published in: Journal of shoulder and elbow surgery 2019-11, Vol.28 (11), p.2072-2078
• Main Authors: McLean, Andrew S., Price, Nathan, Graves, Stephen, Hatton, Alesha, Taylor, Fraser J.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder - statistics & numerical data; Australia; Databases, Factual; epidemiology; Female; Fracture Fixation, Internal - statistics & numerical data; hemiarthroplasty; Hemiarthroplasty - statistics & numerical data; Hospitalization; Humans; Incidence; Male; Middle Aged; Open Fracture Reduction - statistics & numerical data; open reduction–internal fixation; Procedures and Techniques Utilization; Proximal humeral fractures; Retrospective Studies; reverse shoulder arthroplasty; shoulder arthroplasty; Shoulder Fractures - epidemiology; Shoulder Fractures - surgery
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.03.034

There is no consensus as to the treatment of proximal humeral fractures (PHFs), particularly in elderly patients. There is increasing evidence that nonoperative management may have similar functional outcomes to operative management, which is potentially conflicting with increasingly improved surgical techniques and implants. The aim of this study was to investigate the changes in the incidence and management of PHFs across Australia over a 10-year period. We retrospectively reviewed all hospitalizations of patients with PHFs from 2 Australian national health care databases from 2008 to 2017. We recorded the incidence of PHFs and annual utilization rates of commonly used treatment options including nonoperative management, hemiarthroplasty (HA), reverse total shoulder arthroplasty (RTSA), and open reduction–internal fixation (ORIF). The incidence of PHFs increased from 26.8 per 100,000 person-years in 2008 to 45.7 per 100,000 person-years in 2017. There was a decrease in operative management from 2008 to 2017, with 32.5% and 22.8% of all PHFs treated operatively in 2008 and 2017, respectively (P = .001). ORIF use decreased significantly from 76.6% to 72.6% (P = .004). RTSA use increased significantly from 4.1% to 24.5% (P < .001). HA use decreased significantly from 19.3% to 3% (P < .001). Whereas the incidence of PHFs increased, the operative management of PHFs decreased significantly from 2008 to 2017, particularly in patients aged 65 years or older. This decrease in operative management was in part due to a significant decrease in ORIF and HA use in patients aged 65 years or older. There was a significant increase in RTSA use.