Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 12, pp 1713–1721 | Cite as

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

  • Alexander KlugEmail author
  • Yves Gramlich
  • Dennis Wincheringer
  • Kay Schmidt-Horlohé
  • Reinhard Hoffmann
Trauma Surgery



Proximal humeral fractures (PHF) are among the most common adult fractures. However, valid epidemiologic population-based data, including differentiation of treatment modalities, are lacking.

Materials and methods

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 (> 70 years) 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.

Level of evidence

Descriptive epidemiology study, large database analysis.


Proximal humeral fractures Treatment patterns Hemiarthroplasty Reverse shoulder arthroplasty Locking plate Epidemiology 



None of the authors, their immediate families, and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

No ethical approval has been needed for this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Zentrum für Unfallchirurgie und orthopädische ChirurgieBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  2. 2.Orthopaedicum Wiesbaden, Praxis für Orthopädie, Unfallchirurgie und SportmedizinZentrum für EllenbogenchirurgieWiesbadenGermany

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