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. 2021 Dec;92(6):651-657.
doi: 10.1080/17453674.2021.1941629. Epub 2021 Jun 30.

No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures

Carl Bergdahl  1   2 , David Wennergren  1   2 , Eleonora Swensson-Backelin  1 , Jan Ekelund  3 , Michael Möller  1   2
Affiliations

No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures

Carl Bergdahl et al. Acta Orthop. 2021 Dec.

Abstract

Background and purpose - Clear and acknowledged treatment algorithms for proximal humeral fractures (PHFs) are lacking. Nevertheless, a change in treatment trends, including a change towards more reversed shoulder arthroplasties (RSA), has been observed during recent years. We examined the effect of these changes on reoperation rates.Patients and methods - Between 2011 and 2017, 4,070 PHFs treated at Sahlgrenska University Hospital were registered prospectively in the Swedish Fracture Register (SFR) and followed up until 2019 (mean follow-up of 4.5 years). Data on all reoperations were gathered from the SFR and from medical records.Results - The majority of PHFs were treated non-surgically and the proportion increased slightly, but not statistically significantly, during the study period (from 76% to 79%). Of the surgically treated fractures, the proportion fixed with a plate decreased from 47% to 25%, while the use of RSA increased 9-fold (from 2.0% to 19%). 221 patients underwent 302 reoperations. For those primarily treated surgically, the reoperation rate was 17%. Among treatment modalities, plate fixation was associated with the highest reoperation rate (21%). Rate of reoperations remained constant during the study period, both for the entire study cohort and for the surgically treated patientsInterpretation - During the study period, treatment changes that are in accordance with recently published treatment recommendations were observed. However, these treatment changes did not affect the reoperation rate. Treatment with a plate, intramedullary nail, or hemiarthroplasty was associated with the highest reoperation rates. The fact that almost every 4th surgical procedure was a reoperation indicates a need for further improvement of modern treatment concepts for PHFs.

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Figures

Figure 1.
Figure 1.
Trends in treatment of surgically treated proximal humeral fractures (PHFs), presented by treatment modality as the proportion (%) of the total number of surgically treated PHFs for each year during the study period.
Figure 2.
Figure 2.
Kaplan–Meier curves, split by treatment modality, showing risk of reoperation over time.
See this image and copyright information in PMC

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