Trends in the treatment of proximal humerus fractures in the United States Medicare population

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BackgroundMany factors influence the decision-making in the treatment of proximal humerus fractures. With the increasing popularity of reverse shoulder arthroplasty (RSA), treatment strategies for proximal humerus fractures are evolving. The extent to which expanding indications for RSA has impacted the way surgeons treat these fractures is still under question. The purpose of the current study was to determine trends in the treatment of proximal humerus fractures in the United States Medicare population from 2010 to 2019. Materials and methodsThe Mariner subset of the PearlDiver database, a Health Insurance Portability and Accountability Act compliant national insurance database, was queried for Medicare patients who sustained a proximal humerus fracture from 2010 to 2019. Current Procedural Terminology and International Classification of Diseases codes were used to determine which patients were treated nonoperatively vs. operatively in the acute setting. Operative interventions included RSA, hemiarthroplasty, or open reduction internal fixation (ORIF). Poisson regression was used to detect the prevalence trends. Chi-square test was used to detect differences in operative treatment between 2010 and 2019. Descriptive statistics were calculated. Statistical significance was set at <0.05. ResultsIn the Medicare population queried, the prevalence of operative management of proximal humerus fractures remained largely unchanged (6.5% of all fractures treated operatively in 2010, compared to 6.3% of all fractures treated operatively in 2019; P = .64). The utilization of RSA for proximal humerus fractures increased substantially during the last decade (8.9% of operations in 2010, compared to 50.9% of operations in 2019; P ≤ .001). The utilization of hemiarthroplasty has continuously decreased (24.6% of operations in 2010, compared to 5.2% of operations in 2019; P ≤ .001). The utilization of ORIF for these fractures has also decreased during the last decade (69.2% of operations in 2010, compared to 47.7% of operations in 2019; P ≤ .001). ConclusionIn the Medicare population, there was no difference in the proportion of proximal humerus fractures treated operatively over the decade. The use of ORIF and hemiarthroplasty for proximal humerus fractures has declined significantly. More surgeons are utilizing RSA as a treatment for proximal humerus fractures in this patient population.