Humeral Fractures In Adults Research Articles

How does locking plate compare with locking intramedullary nail for treating proximal humeral fractures in adults?

How does locking plate compare with locking intramedullary nail for treating proximal humeral fractures in adults?

How does surgical intervention compare with non-surgical treatment for treating proximal humeral fractures in adults?

How does surgical intervention compare with non-surgical treatment for treating proximal humeral fractures in adults?

Management of Proximal Humeral Fractures in Adults: A Systematic Review and Meta-Analysis.

Differences in function, pain, and reoperation rates were compared between the following treatment options: (1) operative vs. nonoperative treatment and (2) various surgical treatments including open reduction internal fixation, intramedullary nail, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA). MEDLINE, Embase, and Cochrane were searched through February 1, 2022. All English-language randomized trials comparing operative and nonoperative treatment of proximal humeral fractures with a control group in patients 18 years or older were included. Demographic data, functional and pain scores and re-operation rates were extracted. Study quality was determined with the Cochran risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Heterogeneity was determined with the I-squared statistic. Meta-analysis of included studies using mean difference and odds ratios where appropriate. Surgical treatment with either locked plates or HA results in similar functional scores and pain outcomes as nonoperative treatment, although plates were associated with higher reoperation rates in 3-part and 4-part fractures. In 3-part and 4-part fractures, RSA results in higher function and pain scores compared with HA. Further high-quality trials should focus on RSA, and further study is required to better define the role of open reduction internal fixation in the younger patient population. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Mid-Term results in adult humeral fractures with titanium elastic nail fixation versus plate and screw fixation and locking intramedullary nailing

Aims: To compare plate-screw fixation, intramedullary nailing (IMN), and titanium elastic nailing (TEN) as a new fixation method with respect to nonunion, complication rates, and functional outcomes in the repair of adult humeral shaft fractures. Methods: A total of 38 adult patients who were treated due to humeral shaft fracture at our clinic and were followed for minimum six months between January 2012 and January 2015 were retrospectively analyzed. Age, sex, fracture etiology an length of hospitalization were recorded. Fractures were classified according to the Association for Osteosynthesis(AO) classification. Nonunion rates as assessed by X-ray during visits, angulation, shoulder, elbow and hand disability scores were evaluated using the DASH, Mayo Elbow and UCLA Shoulder scoring, and Stewart Hundley criteria. Results: There was no significant epidemiological difference between the groups. The length of hospitalization was lower in the TEN group. There was no significant difference in nonunion rates and functional scores according to the type of treatment. Angulation rate was slightly higher in the TEN group. The effect of angulation on functional score showed no influence on the functional status. The three treatment types mostly achieved excellent and good outcomes. Conclusion: Our study results suggest that TEN seems to be a good alternative treatment in eligible patients with humeral shaft fractures considering complications of other treatments. However, we believe that further, large-scale, randomized-controlled, prospective studies with longer follow-up duration are required to confirm these findings and to establish a definite conclusion. Level of Evidence: Therapeutic Level III.

Epidemiology and trends in management of acute proximal humeral fractures in adults: an observational study of 137,436 cases from the Danish National Patient Register, 1996-2018.

Background and purposeProximal humeral fractures (PHF) can be managed surgically or non-surgically. Locking plates have been the preferred head-preserving surgical technique while hemiarthroplasty (HA) or reverse shoulder arthroplasty (RSA) have been used in joint replacement surgery. We describe the epidemiology and trends in management of acute PHF in Denmark with a focus on (i) changes in the incidence of PHF; (ii) changes in the proportion of surgical cases; and (iii) changes in preferred surgical techniques.Patients and methodsData on diagnoses and interventions was retrieved from the Danish National Patient Register. Patients aged 18 years and above were included. Surgical treatment was defined as the diagnosis of PHF combined with a predefined surgical procedure code within 3 weeks of injury. Data on plate osteosynthesis, HA, RSA, and “other techniques” was retrieved. Non-surgical treatment was defined as no relevant surgical procedure code within 3 weeks.ResultsWe identified 137,436 PHF (72% women) in the Danish National Patient Register. The overall mean incidence was 138/100,000/year (500 for women 60 years or above). Non-surgical treatment accounted for 119,966 (87%). The 17,470 surgical procedures included 42% locking plates, 34% arthroplasties, and 25% other techniques. The rate of surgery declined from 17% in 2013 to 11% in 2018.InterpretationThe overall incidence of PHF remained stable between 1996 and 2018 but the absolute number increased. The approach to PHF remains predominantly non-surgical. The number of surgeries in Denmark have decreased since 2013, especially for locking plates and HA, while RSA is increasingly used.

Is double-crossed retrograde elastic stable intramedullary nailing an alternative method for the treatment of diaphyseal fractures in the adult humerus?

BackgroundThe aim of this study was to compare two techniques for the surgical treatment of diaphyseal fractures in the adult humerus: double-crossed retrograde elastic stable intramedullary nailing (DCR-ESIN) and limited-contact dynamic compression plate (LC-DCP).MethodsThis was a retrospective study conducted at a single hospital. We included 122 patients with diaphyseal fractures of the humerus who had received DCR-ESIN or LC-DCP from January 2011 to January 2017. We compared union rates, union times, disabilities of the arm, shoulder, and hand (DASH) scores at the postoperative 1-year follow-up, and complications between the two groups.ResultsPlating management was performed in 63 patients, while DCR-ESIN was performed in 59 patients. The union rate was higher in the DCR-ESIN group than in the LC-DCP group (100% vs. 90.5%; p = 0.052). The union time was shorter in the DCR-ESIN group than in the LC-DCP group (12.0 weeks vs. 14.8 weeks; p < 0.001). The intraoperative blood loss and operative time were less in the DCR-ESIN group than in the LC-DCP group (76.4 min vs. 129.5 min; p < 0.001; 60.9 ml vs. 244.8 ml; p < 0.001, respectively). The DCR-ESIN had superior results for the rate of overall complications (p = 0.006). At the 1-year follow-up, the DCR-ESIN group had better DASH scores than the LC-DCP group (p = 0.014).ConclusionsThe DCR-ESIN technique, used to treat diaphyseal fractures of the humerus, has shorter operative times, less intra-operative blood loss, shorter union times, and better functional outcomes at 1-year follow-up than the LC-DCP technique. DCR-ESIN may be an alternative method for the surgical treatment of diaphyseal humeral fractures in adults.

Interventions for treating proximal humeral fractures in adults.

Interventions for treating proximal humeral fractures in adults.

Functional Outcomes of Non-operative Treatment in Proximal Humeral Fracture of Adults

Background: The functional outcomes after non-operative treatment of proximal humeral fractures in adults required detailed understanding for improved health outcomes. Objective: To identify the functional outcomes of non-operative treatment in proximal humeral fracture of adults. Study Design: Prospective cohort study Place and Duration of Study: Department of Orthopaedic, KMC Civil Hospital, Khairpur Mirs from 1st October 2020 to 30th September 2021. Methodology: Fifty patients with proximal humeral fracture &gt;45 years were treated with non-operative treatment protocol including 1 year follow-up. Patient’s radiological imaging was continued till one year and they were given a sling to wear for three week’s time. The treatment primary functional outcomes were assessed by Oxford Shoulder Score and EuroQol-5 Dimensions-3 Levels, while secondary functional outcomes were assessed by visual analog scale and university of California Los-Angeles scoring method. Results: Mean age was 65.6±4.2 years with females as 74% and 26% males. Improvement in OSS was up to 48 points. One-year scores for OSS were mean 33.1 with 95% confidence of interval while it was 0.59 for EQ-5D-3L. Mean VAS pain score was 32.1 with 59.2 as VAS satisfaction score and UCLA activity score as 20.4. Conclusion: Non-operative treatment for proximal humeral fracture in adults’ results in significant changes in shoulder-specific as well as improved health outcomes after one year. Key words: Proximal humeral fractures, Non-operative, Bone health

Locking plate fixation with fibular strut allograft versus locking plate fixation alone for the treatment of proximal humeral fractures in adults:a Meta-analysis

To compare the clinical efficacy of locking plate fixation with a fibular strut allograft (FA group) and locking plate fixation alone (LP group) in the treatment of proximal humeral fractures in adults by Meta-analysis. Databases including PubMed, The Cochrane Library, Embase, Chinese BioMedical Literature Database(CBM), China National Knowledge Infrastructure(CNKI), WanFang Data, and China Science and Technology Journal Database (cpvip Database) were searched by computer from establishing to March 2020 to collect studies about locking plate fixation with fibular strut allograft versus locking plate fixation alone for proximal humeral fractures in adults. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. The postoperative humeral head height changes, neck-shaft angle changes, Constant-Murley score, American Shoulder and Elbow Surgeons(ASES)score, visual analogue scale(VAS), varus malunion rate, and screw penetration rate were compared by RevMan 5.3 software for Meta-analysis. Ten cohort studies were enrolled in a total of 749 patients, 300 patients in the FA group and 449 patients in the LP group. The results of Meta-analysis showed that locking plate with fibular strut allograft was superior to locking plate fixation alone in the changes in humeral head height [MD=-2.69, 95%CI(-3.24, -2.13), P<0.000 01], the changes in neck-shaft angle [MD=-5.65, 95%CI(-7.18, -4.12), P<0.000 01], Constant-Murley score [MD=9.00, 95%CI(4.26, 13.73), P=0.000 2], the ASES score [MD=5.56, 95%CI(4.29, 6.84), P=0.000 01], VAS score [MD=-0.23, 95%CI(-0.37, -0.09), P=0.001], the varus malunion rate [RR=0.22, 95%CI(0.09, 0.53), P=0.000 7] and the screw penetration rate [RR=0.26, 95%CI(0.13, 0.55), P=0.000 3], respectively.While there was no significant difference in the rate of osteonecrosis of the humeral head [RR=1.18, 95%CI(0.57, 2.45), P=0.65]. For proximal humeral fractures in adults, current evidence shows that locking plate fixation with fibular strut allograft is superior to single locking plate fixation in improving postoperative radiological outcomes and shoulder function, relieving postoperative pain, reducing varus malunion rate and screw penetration rate. However, the efficacy in decreasing the osteonecrosis rate is not clear. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.

Dynamic compression plating with interlocking nailing for fracture shaft of humerus in adult: A prospective study

Background: In orthopaedics, a humerus fracture is a frequent yet difficult to treat problem. Unless complicated, these are normally treated non-operatively (with a hanging arm cast, U cast, or U slab). Complete union is not always required since the bone has a dense covering of muscles and blood vessels. The goal of this study was to see if there was a difference between dynamic compression plating (DCP) and intramedullary interlocking nailing in diaphyseal humeral fractures in adults. Methods: It was a prospective study undertaken at MGM Medical College and L.S.K. Hospital in Kishanganj, Bihar, in the department of orthopaedics. During the study period of November 2020 to September 2021, a total of 40 cases were enrolled. The participants in the study were randomly assigned to one of two groups. One closed reduction and internal fixation with antegrade intramedullary interlocking nail-group, and one open reduction and internal fixation with dynamic compression plating-group. Results: We found that the final outcome in between the groups, comparison of DASH score, maximum number of excellent cases were Dynamic compression plating group. i.e. 80.0%, good-13.3%, Fair was 6.7% respectively. In another Interlocking nailing group excellent cases were found 26.7%, good-33.3%, fair- 26.7% and poor was 13.3% respectively. We have found statistically significant p value -0.028. Conclusion: There appears to be a substantial difference in radiological union or rate of union between the two groups; nonetheless, based on complications and functional results, Dynamic compression plating is a good fixation method

Wound infection in elbow fractures: Incidence and new management protocol.

Wound infection in elbow fractures: Incidence and new management protocol.

OUTCOMES IN DOUBLE TENSION BAND OSTEOSYNTHESIS IN DISTAL HUMERUS FRACTURES AO TYPE C1

Introduction: Distal humeral fractures accounts for approximately 2% of all fractures and nearly onethird of humeral fractures in adults. In this regard, Double Tension Band Wiring (DTBW) technique was used for the xation of the distal humeral fractures type C1 (AO) to evaluate the early movement and complications of the patients. Methodology: This study was conducted on 38 patients of C1 (AO type)who were subjected to open reduction and internal xation using DTBW techniques, to evaluate the incidence of complications and to evaluate intraoperative parameters and postoperative functional outcomes over a period of 12 months. Results: The mean age of the participants was 43.7 years. The mean tourniquet time was 76 minutes. The mean union time was 11.4 weeks and the mean duration of the follow-ups was 13.72 months. The mean values for the lack of extension, exion, and range of motion were 12.24o, 120.9o, and 108.2o respectively. Neuropraxia was observed in 1 patient who was treated with conservative treatment. Mean MEPS score was 80.15. 17 patients had excellent scores , 12 had good scores and 9 had fair scores. None had poor scores. Hardware prominence was observed in 1 case which was treated with hardware removal after union was achieved. Hardware removal was performed 6 months after the surgery. Moreover, patients were diagnosed with no serious complications, such as the nonunion of fracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of their treatment. Conclusions: Based on the obtained results, it can be concluded that DTBW is an effective technique in AO type C1 fracture xation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration, tourniquet time, and damage caused by soft tissue stripping.

A review of the surgical management of distal humerus fractures and nonunions: From fixation to arthroplasty

Distal humeral fractures in adults are challenging injuries. They often require surgical intervention in form of internal fixation or total elbow arthroplasty which is being increasingly used in physiologically elderly patients with comminuted fractures. Careful preoperative evaluation including type of fracture, quality of bone, pre-existing conditions and functional demand help in deciding optimal treatment. CT scans including 2D and 3D reconstructions are almost mandatory in proper planning of the surgical treatment. In most cases with a healthy physiologically young patient, ORIF is the treatment of choice. Biomechanical studies have shown that parallel plating resists rotational deformity to a greater degree than 90/90 plating allowing supracondylar union. Accurate realignment of articular fragments and compression at the supracondylar area is key to the success of the internal fixation. Main cause of failure of fixation is the nonunion or malunion in the supracondylar area. The principles described by O'Driscoll et al. allow for rigid fixation of the distal articular fragments and compression at the supracondylar level which is vital to healing and the prevention of hardware failure, and nonunion. Olecranon osteotomy improves the expodure of distal humeral articular surface but has its own share of problems and should be avoided if possible. Irritation of ulnar nerve is a common complication so it should be isolated, kept under vision throughout and if necessary, transposed anteiriorly. Nonunion or malunion of supracondylar fractures can be treated by revision ORIF or total elbow arthroplasty (TEA). Supracondylar shortening, bone grafting and contracture release are important elements of treatment of nonunions.In unreconstructable distal humerus fractures, where open reduction and internal fixation is not possible due to the small size of the fragments, severe comminution and/or poor bone quality, TEA is the treatment of choice. Triceps can be left intact as the excision of fractured fragments usually provide enough space to carry out the operation. Sometimes, the decision to perform TEA is only made after exposing the fracture so the surgeon should be comfortable in performing TEA if ORIF is not possible; and necessary instruments and implants should be available on the shelf. In spite of satisfactory outcome, overall complication rate after TEA remains high and makes surgical efficiency and technical competence of utmost importance.

Study of functional outcome of surgical management of distal humerus fractures with bicolumnar plating

INTRODUCTION: Distal humerus fractures in adults comprise 2% of all fractures and 30% of all humeral fractures. Intra-articular distal humerus fractures account for 37% and involve both medial and lateral columns. Most of the distal humeral fractures in adults must be treated surgically to get better functional outcome. The aim of this study was to assess the efficacy, technical requirements, functional outcome, radiological and clinical union, and complications of distal humerus fractures treated with bicolumnar plating. MATERIALS AND METHODS: This was a prospective study of 35 cases of distal humerus fractures conducted at a tertiary care hospital, who were treated surgically with bicolumnar plating using posterior approach with transolecranon osteotomy between 2016 and 2018. The Mayo Elbow Performance Score was used for the assessment of functional outcome. RESULTS: Thirteen (37.14%) patients got excellent outcome, 17 (48.58%) got good outcome, 4 (11.42%) got fair outcome, and 1 (2.86%) got poor outcome, and the complications observed were infections, nonunion, implant failure, and elbow stiffness. Distal end radius fracture was the common association with distal humerus fracture in our study. CONCLUSION: Open reduction and internal fixation with bicolumnar plating is the treatment of choice for distal humerus fracture mainly in type B and C fractures. Fracture types, use of locking plates, stable fixation, and meticulous repair of soft tissues along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion, and prevents stiffness.

Study on functional outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults

Background: The Incidence of trauma related skeletal injuries have been on the rise in recent years and proximal humerus fractures are one of the most common fractures occurring in the human body. Hence the present study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system (PHILOS) technology.The present study was undertaken to assess the functional and radiological outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults. Method:The present prospective observational study was conducted in adults with proximal humerus fractures admitted to department of orthopedics, GSL Medical College and General hospital Rajahmundry during study period from 1st October 2015 to 31st March 2017. The study was approved by the institute’s ethical committee. Patients were undergo Open reduction internal fixation with philos locking plating for the sustained fracture under general anaesthesia. Post-operative physiotherapy followed according to protocol, to evaluate the functional outcome. Result: The average age of patients was 44 years. Males were 16 and females were 09. Most common mechanism of injury observed was Road traffic accident in 72%. The Constant- Murley score was significantly improved (p=.000) over the successive follow-up period. 01 (04%) patient had excellent Constant-Murley scores, 11 (44%) patients had good scores, as like 11 (44%) had moderate scores and only 2 (08%) patients had a poor functional outcome. Conclusion:In conclusion, the proximal humeral locking plate seems to be an adequate device for the fixation of displaced two-part, three-part and four-part proximal humerus fractures. Due to stable fixation, early functional aftercare is possible and allows the patient to regain good shoulder function and resume normal activities much earlier.

Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged &amp;gt;18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1&lt;sup&gt;st&lt;/sup&gt; and 2&lt;sup&gt;nd&lt;/sup&gt; follow-up and around 15 score improvement between 2&lt;sup&gt;nd&lt;/sup&gt; and 3&lt;sup&gt;rd&lt;/sup&gt; follow-up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.&lt;/p&gt;

Outcomes of nonsurgical treatment for transcondylar humeral fractures in adults: Clinical results of nonoperative management.

To elucidate the clinical outcomes of nonsurgical treatment for transcondylar fractures of the humerus.From April 2010 to March 2018, 32 elbows with AO classification 13A-2.3 transcondylar fractures of the humerus (extra-articular fracture, metaphyseal simple, transverse, transmetaphyseal) in adult patients were treated in our hospital and related facilities. Fifteen of 32 elbows were treated nonsurgically by immobilization with a long-arm cast or splint. Of these, 14 elbows that were followed up for >3 months were investigated. The patients comprised 6 men and 8 women with a mean age at the time of injury of 78 years. We investigated the follow-up period, duration until bone union, complications at final follow-up, radiological evaluation, elbow range of motion (ROM), total elbow joint range (Arc), and clinical outcome (Mayo Elbow Performance Score [MEPS]).The mean follow-up period was 8 months. The mean duration until bone union was 7 weeks. No significant complications were observed at the final examination. The ROM of the injured elbow joint was obtained in 13 patients. At the final follow-up, the mean extension and flexion of the injured elbow was −19.2° and 121.2°, respectively. The mean Arc of the injured elbow joint was 102.3°. Joint contracture (<120° flexion) was observed in 6 of the 13 elbows for which ROM was obtained. No patients complained of residual pain of the elbow joint. The mean MEPS was 93.1 points.There is no objection to the fact that displaced transcondylar fractures of the humerus should be treated surgically. However, significant numbers of intraoperative and postoperative complications of plate osteosynthesis have been reported. Until recently, although few clinical reports regarding nonsurgical treatment for these fractures have been published, several studies have indicated that nonsurgical treatment might be an alternative option for these fractures caused by low-energy trauma. In this study, we presented the radiographic and clinical outcomes of nonsurgical treatment for transcondylar fractures of the humerus. Our study suggests that nonsurgical treatment can be a good option for transcondylar fractures of the humerus.

Complications and Long-Term Outcomes of Open Reduction and Plate Fixation of Proximal Humeral Fractures.

The optimal treatment of complex proximal humeral fractures in adults remains controversial. We evaluated the risk of complications and the long-term outcomes in patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus treated with open reduction and plate fixation (ORIF). Between 1995 and 2012, 5,897 consecutive patients with a proximal humeral fracture were referred to a specialist shoulder clinic for surgical assessment. Indications for surgery included anterior or posterior fracture-dislocation, substantial tuberosity involvement with >1 cm of displacement in a Neer 3 or 4-part fracture configuration, disengagement of the head from the shaft, or severe varus or valgus deformity of the head. All patients who met the surgical criteria and had been followed for 2 years were included, and standardized clinical and radiographic assessments of outcomes were performed. At a median of 10.8 years (range, 5 to 22 years) after ORIF, all surviving cognitively intact patients completed a patient-reported questionnaire assessing functional outcomes and satisfaction. Three hundred and sixty-eight patients (6.2%) met the inclusion criteria and had the appropriate follow-up. The study population had a high rate of complex fracture configurations; 77.2% had tuberosity involvement, 54.1% had complete head-shaft disengagement, and 44.0% had a dislocated head. Eighty-seven patients (23.6%) had postoperative stiffness, 25 (6.8%) had fixation failure/nonunion, and 16 (4.3%) had late osteonecrosis/posttraumatic osteoarthritis; these complications were the reason for the majority of the reoperations in the cohort. The survivorship until any reoperation was 74% at 10 years, but when reoperations for stiffness were excluded, the survivorship was 90% during the same time period. The patients' mean levels of pain, function, and satisfaction with treatment were good to excellent. Our results support the use of primary ORIF in medically fit patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus in centers where the expertise to carry out such treatment exists. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Distal humeral fractures in the adult

The management of distal humeral fractures in adults presents a unique set of challenges. Almost always they necessitate operative management, which might include complex intra-articular fracture fixation of very comminuted free fragments in an already complex joint, or, increasingly, novel arthroplasty techniques. Clinicians managing these injuries must be confident that they possess the requisite skills set, and, in the UK at least, this in itself is under scrutiny. This summary aims to acquaint the reader with the basic knowledge sufficient to begin to understand the approaches to managing these injuries, and some of the decision-making difficulties that are encountered.

Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016.

Proximal humeral fractures (PHF) are among the most common adult fractures. However, valid epidemiologic population-based data, including differentiation of treatment modalities, are lacking. Using the ICD codes and associated OPS codes for PHF, a retrospective analysis of 2007-2016 Federal Statistical Office of Germany data was performed. Data were evaluated for total incidence of PHF as well as total use, annual utilization rates, age, and sex distributions of all associated surgical procedures. Simple linear regressions were performed to evaluate trends in treatment modalities. There were 642,556 cases of PHF. During the study period, incidence changed substantially from 65.2 to 74.2 per 100,000 inhabitants with a significant rise in elderly (> 70years) patients (P < 0.001). The number of surgical procedures increased by 39%, with locking plate fixation being the most common procedure (48.3%), followed by intramedullary nailing (IMN) (20.0%), hemiarthroplasty (HA) (7.5%), K-wire fixation (6.4%), and reverse shoulder arthroplasty (RSA) (5.6%). The utilization rate increased for locking plates, K-wires, and RSA and decreased for HA and IMN. Particularly, the utilization of RSA exhibited a > eightfold increase. Significant linear correlation of procedure and time were found for all surgical treatments. During this period, the number of inpatient PHFs, especially in the elderly, increased. Although locking plate fixation remained the most common treatment method, RSA had the greatest proportional increase over time, supporting its growing popularity in the light of the current scientific evidence. This incline was offset by a corresponding decrease in HA and IMN, which may be related to a growing knowledge of their application limitations. Descriptive epidemiology study, large database analysis.