Trends in the treatment of proximal humerus fractures from 2010 to 2020

Abstract

The purpose of this study is to examine and compare trends in the treatment of proximal humerus fractures (PHF) (nonoperative versus operative; different surgical treatments) across different age groups over the last decade (2010-2020). The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried using ICD and CPT codes to identify all patients presenting with or undergoing surgery for PHF between 2010-2020. Treatment trends, demographics, and insurance information was analyzed during the study period. Comparisons were made between operative and nonoperative trends with respect to the number and type of surgeries performed amongst three age groups: <49 years, 50-65 years, and >65 years. The rate of postoperative complications and reoperations was evaluated and compared among different surgical treatments for patients with a minimum one-year postoperative follow-up. A total of 92,308 patients were included with a mean age of 67.8 +/- 16.8 years. Over the last decade, there was no significant increase in the percentage of PHFs treated with surgery. A total of 15,523 PHFs (16.82%) were treated operatively and these patients, compared to the nonoperative cohort, were younger (64.9 years versus 68.4 years, p<0.001), more likely to be white (80.2% versus 74.7%, p<0.001), and more likely to have private insurance (41.4% versus 32.0%, p<0.001). For patients <49 years old, trends in operative treatment have remained stable with internal fixation (IF) as the most utilized surgical modality. For patients 50-64 years old we observed a gradual decline in the utilization of hemiarthroplasty (HA), with a corresponding increase in utilization of reverse total shoulder arthroplasty (rTSA) but IF continued to be the most utilized operative modality. In patients over 65, a steep decline in the use of IF and HA was noted during the first half of the decade along with a significant exponential increase in the utilization of rTSA, which surpassed the use of IF in 2019. Despite the increase in utilization of rTSA no differences in rate of surgical complications were noted between rTSA and IF (χ2=0.245, p=0.621) or reoperations (χ2 =0.112, p=0.730). Nonsurgical treatment remains the mainstay treatment of PHFs. Although there is no increase in prevalence of operative treatment in patients >50 years in the last decade, there is an exponential increase in the utilization of rTSA with a corresponding decrease in HA and IF, a trend more substantial in patients >65 years compared to patients between 50-64 years.