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. 2022 Nov 2;7(4):e22.00008.
doi: 10.2106/JBJS.OA.22.00008. eCollection 2022 Oct-Dec.

Trends in Surgical Treatment of Proximal Humeral Fractures and Analysis of Postoperative Complications Over a Decade in 384,158 Patients

Rami G Alrabaa  1 , Gabrielle Ma  1 , Nicole M Truong  1 , Drew A Lansdown  1 , Brian T Feeley  1 , Alan L Zhang  1 , C Benjamin Ma  1
Affiliations

Trends in Surgical Treatment of Proximal Humeral Fractures and Analysis of Postoperative Complications Over a Decade in 384,158 Patients

Rami G Alrabaa et al. JB JS Open Access. .

Abstract

Surgical treatment options for proximal humeral fractures include hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), and open reduction and internal fixation (ORIF). The objectives of this study were to analyze the trends in surgical treatment of proximal humeral fractures across a decade and to compare complications, reoperation rates, and readmission rates between ORIF and RSA.

Methods: The PearlDiver MUExtr Database was used to identify patients with proximal humeral fractures who were treated with ORIF, HA, or RSA between 2010 and 2019 and analyze yearly trends. Complications, revision procedures, demographic characteristics, comorbidities, and emergency room visits and hospital readmissions within 90 days of the surgical procedure were compared between ORIF and RSA cohorts for patients who had at least 2-year follow-up data.

Results: In this study, 384,158 patients with proximal humeral fractures were identified in the 10-year period between 2010 and 2019. There was a significant increase in the frequency of RSA and a decrease in the frequency of ORIF and HA over time (p < 0.0001). Compared with patients who underwent ORIF or HA, patients who underwent RSA were more likely to be older (p < 0.0001), to be female, and to have a higher Charlson Comorbidity Index. Patients who underwent ORIF had higher complication rates (23.03% compared with 18.62%; p < 0.0001) and higher reoperation rates (20.3% compared with 10.3%; p < 0.0001) than patients who underwent RSA. Patients who underwent RSA had higher emergency room visit rates (20.0% compared with 16.7%; p < 0.001) and hospital readmission rates (12.9% compared with 7.3%; p < 0.0001) within 90 days of the surgical procedure compared with patients who underwent ORIF.

Conclusions: There has been an increasing trend in RSA utilization for the surgical treatment of proximal humeral fractures, along with a decreasing trend in HA and ORIF, over time. Patients who underwent ORIF for a proximal humeral fracture had higher complication and reoperation rates compared with patients who underwent RSA. Patients who underwent RSA had higher emergency room visit and hospital readmission rates within 90 days of the surgical procedure compared with patients who underwent ORIF, which may be attributable to the RSA cohort being older and having more comorbidities.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A431).

Figures

Fig. 1
Fig. 1
Frequency of ORIF, HA, and RSA used for treatment of proximal humeral fractures in all patients between 2010 and 2019. There was a significant increasing trend in RSA rates and decreasing trends in HA and ORIF rates (p < 0.0001).
Fig. 2
Fig. 2
Flow diagram of patients identified between 2015 and 2018 who sustained a proximal humeral fracture treated with ORIF or RSA and had 2-year follow-up data available.
Fig. 3
Fig. 3
The complication rate was higher for patients with a proximal humeral fracture who underwent ORIF compared with those who underwent RSA (23.03% compared with 18.62%; p < 0.0001). Patients included in these cohorts had at least 2 years of active data.
Fig. 4
Fig. 4
The reoperation rate was higher for patients with a proximal humeral fracture who underwent ORIF compared with those who underwent RSA (20.3% compared with 10.3%; p < 0.0001). Patients included in these cohorts had at least 2 years of active data.
Fig. 5
Fig. 5
Patients who underwent RSA for a proximal humeral fracture had higher rates of emergency room visits (ERV) and higher rates of hospital readmissions (HR), compared with patients who underwent ORIF, within 90 days of the surgical procedure.
See this image and copyright information in PMC

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