Proximal humerus fractures: epidemiology and trends in surgical management of hospital-admitted patients in Portugal

Abstract

Background: Proximal humerus fractures (PHFs) are frequent and associated with significant health care burden. National epidemiological data are limited. Our objective is to characterize the Portuguese population admitted with PHFs and analyze therapeutic management, the impact of associated lesions, and mortality rate.

Methods: This was a retrospective, observational study of admissions from mainland public hospitals (2000-2015), with primary or secondary diagnosis of PHFs. Incomplete records, pathologic lesions, malunion/nonunion, and hardware removal were excluded. Age, gender, admission date, hospitalization period, associated injuries, treatment, and mortality were recorded.

Results: A total of 19,290 patients were included. Through the analyzed period, an increase in the absolute number and incidence of PHFs was observed. The mean age at diagnosis was 62.6 ± 21.0 years old (57% elderly; 63.5% female). The mean length of stay was 10.0 ± 14.1 days, higher in patients submitted to arthroplasty (P < .001) and in those with associated fractures (25%; P < .001). A total of 14,482 patients were operated, most frequently with open reduction and internal fixation (28%). The inpatient mortality rate was 3.2%, significantly higher in patients with associated fractures (odds 2.77 for lower limb vs. upper limb).

Conclusion: There is a trend toward an increase in surgical management of PHFs. The relative proportion of open reduction and internal fixation and arthroplasty (particularly reverse arthroplasty) increased, probably reflecting biomechanical implant properties, fracture pattern, and demand for better functionality. Associated fractures are an important comorbidity, associated with increased mortality and length of stay.

Keywords: Epidemiology; Hemiarthroplasty; Humeral fractures; Osteosynthesis; Reverse arthroplasty; Shoulder.

Figure 1

Absolute number of patients hospitalized with proximal humerus fractures, between 2000 and 2015, by gender. PHF, proximal humerus fracture.

Figure 2

Mean age of hospitalized patients, diagnosed with proximal humerus fracture, by year.

Figure 3

Absolute number of surgeries for proximal humerus fractures performed between 2000 and 2015.

Figure 4

Relative distribution of surgical treatment of PHF. PHF, proximal humerus fracture; CRIF, closed reduction and internal fixation; ORIF, open reduction and internal fixation; CR no IF, closed reduction, no internal fixation.

Figure 5

Relative distribution of surgical main procedures, by year. CRIF, closed reduction and internal fixation; ORIF, open reduction and internal fixation.

Figure 6

Relative distribution of shoulder arthroplasty procedures, by year. Hemiarthro, hemiarthroplasty; TSA, total shoulder arthroplasty; RSA, reverse shoulder arthroplasty. Note that the ICD-9 coding for RSA was only introduced in 2021 (before this year, RSA might have been codified elsewhere).