Abstract
Background and purpose — Clear and acknowledged treatment algorithms for proximal humeral fractures (PHFs) are lacking. Nevertheless, a change in treatment trends, including a change towards more reversed shoulder arthroplasties (RSA), has been observed during recent years. We examined the effect of these changes on reoperation rates. Patients and methods — Between 2011 and 2017, 4,070 PHFs treated at Sahlgrenska University Hospital were registered prospectively in the Swedish Fracture Register (SFR) and followed up until 2019 (mean follow-up of 4.5 years). Data on all reoperations were gathered from the SFR and from medical records. Results — The majority of PHFs were treated non-surgically and the proportion increased slightly, but not statistically significantly, during the study period (from 76% to 79%). Of the surgically treated fractures, the proportion fixed with a plate decreased from 47% to 25%, while the use of RSA increased 9-fold (from 2.0% to 19%). 221 patients underwent 302 reoperations. For those primarily treated surgically, the reoperation rate was 17%. Among treatment modalities, plate fixation was associated with the highest reoperation rate (21%). Rate of reoperations remained constant during the study period, both for the entire study cohort and for the surgically treated patients Interpretation — During the study period, treatment changes that are in accordance with recently published treatment recommendations were observed. However, these treatment changes did not affect the reoperation rate. Treatment with a plate, intramedullary nail, or hemiarthroplasty was associated with the highest reoperation rates. The fact that almost every 4th surgical procedure was a reoperation indicates a need for further improvement of modern treatment concepts for PHFs.
Highlights
Every year in Sweden, approximately 140,000 persons sustain fractures and the incidence of fractures has been projected to increase.[1,2,3] In addition to affecting the everyday life of many people, these fractures consume larges economic and social resources.[4]
4.1 STUDY Study population In the National Patient Register (NPR), 2,197 acute humeral fractures were reported in 1,876 patients at Sahlgrenska University Hospital during the study period
Via cross-matching by personal identity number (PIN), 1,375 registrations matched in both registers and were regarded as true, actual humeral fractures
Summary
Every year in Sweden, approximately 140,000 persons sustain fractures and the incidence of fractures has been projected to increase.[1,2,3] In addition to affecting the everyday life of many people, these fractures consume larges economic and social resources.[4]. Conducting research on patients that have sustained a fracture is difficult. The acute nature of fractures, the fact that there is great heterogeneity between fractures in the same location and that patients of all ages and backgrounds are affected contribute to the difficulty involved in fracture research. The development of new surgical techniques and the introduction of new implants, supported by the results of small case series, have influenced the way fractures are treated.[5,6,7] the implications of study results for everyday clinical practice can be difficult to predict. Outside the strict setting of clinicals trials, the positive results of these case series have often been difficult to reproduce.[7,8,9] Today, few evidence-based guidelines exist to help direct clinicians in treatment decisions for different fractures.[10]
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