Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;12(2):103-112.
doi: 10.1302/2046-3758.122.BJR-2022-0275.R1.

Proximal humerus fractures - epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data

Nike Walter  1 , Dominik Szymski  1 , Steven M Kurtz  2 , David W Lowenberg  3 , Volker Alt  1 , Edmund Lau  4 , Markus Rupp  1
Affiliations

Proximal humerus fractures - epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data

Nike Walter et al. Bone Joint Res. 2023 Feb.

Abstract

Aims: The optimal choice of management for proximal humerus fractures (PHFs) has been increasingly discussed in the literature, and this work aimed to answer the following questions: 1) what are the incidence rates of PHF in the geriatric population in the USA; 2) what is the mortality rate after PHF in the elderly population, specifically for distinct treatment procedures; and 3) what factors influence the mortality rate?

Methods: PHFs occurring between 1 January 2009 and 31 December 2019 were identified from the Medicare physician service records. Incidence rates were determined, mortality rates were calculated, and semiparametric Cox regression was applied, incorporating 23 demographic, clinical, and socioeconomic covariates, to compare the mortality risk between treatments.

Results: From 2009 to 2019, the incidence decreased by 11.85% from 300.4 cases/100,000 enrollees to 266.3 cases/100,000 enrollees, although this was not statistically significant (z = -1.47, p = 0.142). In comparison to matched Medicare patients without a PHF, but of the same five-year age group and sex, a mean survival difference of -17.3% was observed. The one-year mortality rate was higher after nonoperative treatment with 16.4% compared to surgical treatment with 9.3% (hazard ratio (HR) = 1.29, 95% confidence interval (CI) 1.23 to 1.36; p < 0.001) and to shoulder arthroplasty with 7.4% (HR = 1.45, 95% CI 1.33 to 1.58; p < 0.001). Statistically significant mortality risk factors after operative treatment included age older than 75 years, male sex, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, chronic kidney disease, a concomitant fracture, congestive heart failure, and osteoporotic fracture.

Conclusion: Mortality risk factors for distinct treatment modes after PHF in elderly patients could be identified, which may guide clinical decision-making.Cite this article: Bone Joint Res 2023;12(2):103-112.

Keywords: Cox regression models; Epidemiology; Management; Mortality; Physicians; Proximal humerus fracture; Surgical treatment; chronic kidney disease; chronic obstructive pulmonary disease; epidemiology; fracture of the proximal humerus; nonoperative management; osteoporotic fractures; shoulder arthroplasty procedure.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Historic development of age- and sex-specific incidence rates of proximal humerus fractures.
Fig. 2
Fig. 2
Survival of patient after proximal humerus fracture (PHF) in comparison to age- and sex-matched Medicare enrollee without PHF.
Fig. 3
Fig. 3
Survival of patient after proximal humerus fracture dependent on the treatment procedure.
See this image and copyright information in PMC

References

    1. Court-Brown CM, McQueen MM. Global forum: Fractures in the elderly. J Bone Joint Surg Am. 2016;98-A(9):e36. 10.2106/JBJS.15.00793 - DOI - PubMed
    1. Rupp M, Walter N, Pfeifer C, et al. The incidence of fractures among the adult population of Germany–an analysis from 2009 through 2019. Dtsch Arztebl Int. 2021;118(40):665–669. 10.3238/arztebl.m2021.0238 - DOI - PMC - PubMed
    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691–697. 10.1016/j.injury.2006.04.130 - DOI - PubMed
    1. Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly P. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis. Bone Joint Res. 2016;5(10):470–480. 10.1302/2046-3758.510.2000638 - DOI - PMC - PubMed
    1. Kim SH, Szabo RM, Marder RA. Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res (Hoboken). 2012;64(3):407–414. 10.1002/acr.21563 - DOI - PubMed