Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012

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• 作者：Samuel Rosas ; MS^a ; Tsun Yee Law ; MD^a ; Jennifer Kurowicki ; BS^a ; Nate Formaini ; DO^b ; Steven P. Kalandiak ; MD^c ; Jonathan C. Levy ; MD^b ; ^{jonlevy123@yahoo.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Descriptive Epidemiology Study ; Large Database Analysis
• 刊名：Journal of Shoulder and Elbow Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：25
• 期：4
• 页码：608-613
• 全文大小：550 K

文摘

Surgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population.

Methods

We retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated.

Results

Within the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume (P = .119). The percentage of fractures treated surgically decreased significantly from 16.2% to 13.9% (P < .001). The utilization rate decreased significantly for HA from 52% to 39% (P < .001), increased significantly for RSA from 11% to 28% (P < .001), and did not change significantly for ORIF (P = .164). The utilization rate of RSA nearly tripled for patients older than 65 years (11% to 29%) and doubled for patients younger than 65 (6% to 12%).

Conclusion

From 2009 to 2012, utilization rates of ORIF remained fairly constant. HA remains the most commonly used surgical treatment for proximal humeral fractures in the Medicare population, but its use has declined significantly. This decline has been offset by a corresponding increase in RSA.