Decreasing Rate of Operative Management of Proximal Humerus Fractures in Adolescents: A National Database Study

Abstract

Background: There is no consensus on the operative treatment of adolescent proximal humerus fractures. The purpose of this study was to investigate the trends in treatment of proximal humerus fractures in adolescents and identify predictors of operative management. Methods: The Pediatric Health Information System database was used to identify patients ages 10 to 18 diagnosed with proximal humerus fractures between 2004 to 2019. Open fractures were excluded from the analysis. Descriptive, univariate, and multivariate analyses were used to determine trends and predictors of operative management. Results: A total of 17,515 proximal humerus fracture admissions were identified and 2081 (11.9%) were treated operatively. The mean age was 12.5 years and 37.5% of patients were female. The rate of operative management decreased from 15.1% to 8.9 during the study period (p<0.01). There was a higher rate of operative management in boys (13.4% vs. 9.4%, p< 0.01). The operative cohort was older (13.4 years vs. 12.4 years, p<0.01), and patients who lived in rural areas had twice the rate of operative management (20.7% vs. 10.8%, p<0.01). Operative patients had higher billed charges and longer hospital stay (p < 0.05), but there was no significant difference in mean estimated household income between operative and nonoperative groups (p > 0.05). A multivariate analysis showed increased odds of operative management with older age (OR 1.32, 1.29-1.36), and residence in the South (OR 1.19, 1.05-1.34). The odds of operative management were lower in more recent years (OR 0.94, 0.93-0.95) and in urban settings (OR 0.41, 0.35-0.47). Conclusion: From 2004 to 2019, there has been a significant decrease in the rate of operative management of adolescent proximal humerus fractures at children’s hospitals. Patients who are older, male, or reside in rural areas or the South are more likely to be treated operatively.