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. 2017 Sep;18(3):259-263.
doi: 10.1007/s10195-017-0459-6. Epub 2017 May 8.

Humeral shaft fractures: national trends in management

Bradley S Schoch  1 , Eric M Padegimas  2 , Mitchell Maltenfort  3 , James Krieg  3 , Surena Namdari  4
Affiliations

Humeral shaft fractures: national trends in management

Bradley S Schoch et al. J Orthop Traumatol. 2017 Sep.

Abstract

Background: The incidence of humeral shaft fractures has been increasing over time. This represents a growing public health concern in a climate of cost containment. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention.

Materials and methods: Humeral shaft fractures were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 812.21 and 812.31 in the United States Nationwide Inpatient Sample from 2002 to 2011. Open reduction and internal fixation (ORIF) was identified by code 79.31 (ORIF, humerus). Other case codes analyzed were 79.01 (closed reduction without internal fixation), 79.11 (closed reduction with internal fixation), and 79.21 (open reduction without internal fixation). Multivariate regression analysis was utilized to determine predictive factors for utilization of ORIF.

Results: 27,908 humeral shaft fractures were identified. Utilization of ORIF increased from 47.2% of humeral shaft fractures in 2002 to 60.3% in 2011. Demographically, patients who underwent ORIF were younger (51.5 versus 59.7 years, p < 0.001; odds ratio 0.87 per decade of age). There were modest increases in ORIF usage with private insurance, open fracture, and hospital size, which persisted with multivariate regression analysis. Surprisingly, there was a tendency to shift from a slight increase in ORIF for males with the bivariate case to a slight preference for females in the multivariate case.

Conclusion: Utilization of ORIF for humeral shaft fractures has been steadily increasing with time. Surgical intervention was more common with younger patients, female gender, private insurance, and larger hospital size. The increasing incidence of surgical management for humeral shaft fractures may represent a public health burden given the historical success of non-operative management.

Level of evidence: IV.

Keywords: Humerus fracture; NIS; Nationwide inpatient sample; Non-operative; Open reduction internal fixation.

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Conflict of interest statement

Conflict of interest

Bradley Schoch is a paid speaker for DJO. James Krieg is a paid consultant for Conventus, Merck, and Synthes. James Krieg owns stock in Conventus, Domain Surgical, MDLive, and Trice Medical. James Krieg receives royalties from Synthes and SAM Medical. Surena Namdari receives divisional research funding from Depuy, Zimmer, Integra Life Sciences, and Arthrex. Surena Namdari is a paid consultant for DJO Surgical, Integra Life Sciences, and Miami Device Solutions. Surena Namdari receives royalty payments from DJO Surgical, Miami Device Solutions, and Elsevier. The authors declare that they have no conflict of interest in relation to this manuscript.

Patient consent

Unnecessary, since data is obtained from a public data base of anonymized patients.

Ethical approval

Unnecessary, since data is obtained from a public data base of anonymized patients.

Funding

No external funding was received for this study.

Figures

Fig. 1
Fig. 1
Annual trend of utilization of all treatment modalities for humeral shaft fractures
Fig. 2
Fig. 2
Annual trend of operative and non-operative management of humeral shaft fractures
Fig. 3
Fig. 3
Utilization of operative intervention for humeral shaft fractures by age
See this image and copyright information in PMC

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