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. 2021 Oct 13;6(1):137-143.
doi: 10.1016/j.jseint.2021.08.006. eCollection 2022 Jan.

Trending a decade of proximal humerus fracture management in older adults

Akshar H Patel  1 , J Heath Wilder  1 , Sione A Ofa  1 , Olivia C Lee  1   2   3 , Felix H Savoie 3rd  1 , Michael J O'Brien  1 , William F Sherman  1
Affiliations

Trending a decade of proximal humerus fracture management in older adults

Akshar H Patel et al. JSES Int. .

Abstract

Background: Proximal humerus fractures are the third most common fracture in older adults. Because of the aging population, the incidence of these fractures and their impact will continue to grow. With advancement in treatment options for proximal humeral fractures, the aim of this study was to evaluate the trends in acute management of proximal humerus fractures to determine how definitive treatment has changed over the past decade in patients older than 65 years.

Methods: Using a commercially available database, patient records were queried from 2010 to 2019 for the incidence of proximal humerus fractures. For each individual year, data were queried to identify the incidence of closed reduction percutaneous pinning (CRPP), hemiarthroplasty (HA), intramedullary nailing (IMN), open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), or nonoperative treatment for acute proximal humeral fractures. A Cochran-Armitage trend test was used to determine significant changes in the trends of proximal humerus fracture management. Logistic regression analyses were performed to generate odds ratios (OR) with associated 95% confidence intervals comparing each individual procedure performed in 2019 to 2010.

Results: A total of 160,836 patients at least 65 years of age and older were diagnosed with a proximal humerus fracture. Of this total, 28,503 (17.72%) patients received operative treatment and 132,333 (82.28%) received nonoperative treatment. From 2010 to 2019, operative treatment trends of proximal humerus fractures changed such that CRPP decreased by 60.0%, HA decreased by 81.4%, IMN decreased by 81.9%, ORIF decreased by 25.7%, TSA decreased by 80.5%, and RSA increased by 1841.4% (all P < .0001). Overall, nonsurgical management increased from 80% to 85% during the examined study period (P < .0001). Patients in 2019 were significantly more likely to receive an RSA (OR 22.65) and were significantly less likely to receive CRPP (OR 0.45), HA (OR 0.20), IMN (OR 0.20), ORIF (OR 0.82), and TSA (OR 0.22) than patients in 2010. In addition, patients in 2019 were significantly more likely to receive nonoperative treatment than patients in 2010 (OR 1.10).

Conclusion: Over the past decade, most of older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. Although CRPP, IMN, HA, ORIF, and TSA have decreased, RSA has recently become more widely utilized, which is consistent with what has been noted in other countries. Continued examination of the mid- and long-term outcomes of the increasing percentages in RSA should be performed in this population.

Keywords: Elderly; Hemiarthroplasty; Internal fixation; Proximal humerus fracture; Reverse shoulder arthroplasty; Total shoulder arthroplasty.

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Figures

Figure 1
Figure 1
The flow diagram of patients included in the study. Fx, fracture; Hx, history.
Figure 2
Figure 2
The proportional trend of acute operative treatments given to elderly patients in 2010-2019 after sustaining a proximal humerus fracture. CRPP, closed reduction percutaneous pinning; Hemi, hemiarthroplasty; IMN, intramedullary nailing; ORIF, open reduction internal fixation; TSA, total shoulder arthroplasty; RSA, reverse total shoulder arthroplasty.
Figure 3
Figure 3
Proportional changes in treatments from 2010 to 2019. (A) Breakdown of treatments in 2010. (B) Breakdown of treatments in 2019.
See this image and copyright information in PMC

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