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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
  • 136 Downloads

Abstract

Introduction

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

Funding

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.

References

  1. 1.
    Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697.  https://doi.org/10.1016/j.injury.2006.04.130 CrossRefPubMedGoogle Scholar
  2. 2.
    Huttunen TT, Launonen AP, Pihlajamäki H et al (2012) Trends in the surgical treatment of proximal humeral fractures—a nationwide 23-year study in Finland. BMC Musculoskelet Disord 13:261.  https://doi.org/10.1186/1471-2474-13-261 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Palvanen M, Kannus P, Niemi S et al (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92CrossRefGoogle Scholar
  4. 4.
    Neer CS (1987) Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res (223):3–10Google Scholar
  5. 5.
    Iyengar JJ, Devcic Z, Sproul RC et al (2011) Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma 25(10):612–617.  https://doi.org/10.1097/BOT.0b013e3182008df8 CrossRefPubMedGoogle Scholar
  6. 6.
    Koval KJ, Gallagher MA, Marsicano JG et al (1997) Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am 79(2):203–207CrossRefGoogle Scholar
  7. 7.
    Bell J-E, Leung BC, Spratt KF et al (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 93(2):121–131.  https://doi.org/10.2106/JBJS.I.01505 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Beks RB, Ochen Y, Frima H et al (2018) Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg 27(8):1526–1534.  https://doi.org/10.1016/j.jse.2018.03.009 CrossRefPubMedGoogle Scholar
  9. 9.
    Khatib O, Onyekwelu I, Zuckerman JD (2014) The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older. J Shoulder Elbow Surg 23(9):1356–1362.  https://doi.org/10.1016/j.jse.2013.12.034 CrossRefPubMedGoogle Scholar
  10. 10.
    Sabesan VJ, Lombardo D, Petersen-Fitts G et al (2017) National trends in proximal humerus fracture treatment patterns. Aging Clin Exp Res 29(6):1277–1283.  https://doi.org/10.1007/s40520-016-0695-2 CrossRefPubMedGoogle Scholar
  11. 11.
    Olerud P, Ahrengart L, Ponzer S et al (2011) Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20(7):1025–1033.  https://doi.org/10.1016/j.jse.2011.04.016 CrossRefPubMedGoogle Scholar
  12. 12.
    Olerud P, Ahrengart L, Ponzer S et al (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20(5):747–755.  https://doi.org/10.1016/j.jse.2010.12.018 CrossRefPubMedGoogle Scholar
  13. 13.
    Du S, Ye J, Chen H et al (2017) Interventions for Treating 3- or 4-part proximal humeral fractures in elderly patient: a network meta-analysis of randomized controlled trials. Int J Surg 48:240–246.  https://doi.org/10.1016/j.ijsu.2017.09.002 CrossRefPubMedGoogle Scholar
  14. 14.
    Handoll HHG, Brorson S (2015) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000434.pub4
  15. 15.
    Schliemann B, Siemoneit J, Theisen C et al (2012) Complex fractures of the proximal humerus in the elderly–outcome and complications after locking plate fixation. Musculoskelet Surg 96(Suppl 1):S3–11.  https://doi.org/10.1007/s12306-012-0181-8 CrossRefPubMedGoogle Scholar
  16. 16.
    Südkamp N, Bayer J, Hepp P et al (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91(6):1320–1328.  https://doi.org/10.2106/JBJS.H.00006 CrossRefPubMedGoogle Scholar
  17. 17.
    Dai J, Chai Y, Wang C et al (2014) Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures. Eur J Orthop Surg Traumatol 24(3):305–313.  https://doi.org/10.1007/s00590-013-1179-0 CrossRefPubMedGoogle Scholar
  18. 18.
    Maier D, Jaeger M, Izadpanah K et al (2014) Proximal humeral fracture treatment in adults. J Bone Joint Surg Am 96(3):251–261.  https://doi.org/10.2106/JBJS.L.01293 CrossRefPubMedGoogle Scholar
  19. 19.
    Bufquin T, Hersan A, Hubert L et al (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: A prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 89(4):516–520.  https://doi.org/10.1302/0301-620X.89B4.18435 CrossRefPubMedGoogle Scholar
  20. 20.
    Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A et al (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23(10):1419–1426.  https://doi.org/10.1016/j.jse.2014.06.035 CrossRefPubMedGoogle Scholar
  21. 21.
    van der Merwe M, Boyle MJ, Frampton CMA et al (2017) Reverse shoulder arthroplasty compared with hemiarthroplasty in the treatment of acute proximal humeral fractures. J Shoulder Elbow Surg 26(9):1539–1545.  https://doi.org/10.1016/j.jse.2017.02.005 CrossRefPubMedGoogle Scholar
  22. 22.
    Austin DC, Torchia MT, Cozzolino NH et al (2018) Decreased reoperations and improved outcomes with reverse total shoulder arthroplasty in comparison to hemiarthroplasty for geriatric proximal humerus fractures: a systematic review and meta-analysis. J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000001321
  23. 23.
    Rosas S, Law TY, Kurowicki J et al (2016) Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012. J Shoulder Elbow Surg 25(4):608–613.  https://doi.org/10.1016/j.jse.2015.08.011 CrossRefPubMedGoogle Scholar
  24. 24.
    Gupta AK, Harris JD, Erickson BJ et al (2015) Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma 29(1):54–59.  https://doi.org/10.1097/BOT.0000000000000229 CrossRefPubMedGoogle Scholar
  25. 25.
    Lanting B, MacDermid J, Drosdowech D et al (2008) Proximal humeral fractures: A systematic review of treatment modalities. J Shoulder Elbow Surg 17(1):42–54.  https://doi.org/10.1016/j.jse.2007.03.016 CrossRefGoogle Scholar
  26. 26.
    Sumrein BO, Huttunen TT, Launonen AP et al (2017) Proximal humeral fractures in Sweden—a registry-based study. Osteoporos Int 28(3):901–907.  https://doi.org/10.1007/s00198-016-3808-z CrossRefPubMedGoogle Scholar
  27. 27.
    Mahabier KC, Hartog DD, van Veldhuizen J et al (2015) Trends in incidence rate, health care consumption, and costs for patients admitted with a humeral fracture in The Netherlands between 1986 and 2012. Injury 46(10):1930–1937.  https://doi.org/10.1016/j.injury.2015.07.025 CrossRefPubMedGoogle Scholar
  28. 28.
    Handoll HH, Keding A, Corbacho B et al (2017) Five-year follow-up results of the PROFHER trial comparing operative and non-operative treatment of adults with a displaced fracture of the proximal humerus. Bone Joint J 99-B(3):383–392.  https://doi.org/10.1302/0301-620X.99B3.BJJ-2016-1028 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Rangan A, Handoll H, Brealey S et al (2015) Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: The PROFHER randomized clinical trial. JAMA 313(10):1037–1047.  https://doi.org/10.1001/jama.2015.1629 CrossRefPubMedGoogle Scholar
  30. 30.
    Thanasas C, Kontakis G, Angoules A et al (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg 18(6):837–844.  https://doi.org/10.1016/j.jse.2009.06.004 CrossRefPubMedGoogle Scholar
  31. 31.
    Brunner A, Weller K, Thormann S et al (2010) Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the Humerusblock. J Orthop Trauma 24(7):407–413.  https://doi.org/10.1097/BOT.0b013e3181c81b1c CrossRefPubMedGoogle Scholar
  32. 32.
    Carbone S, Tangari M, Gumina S et al (2012) Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning. Int Orthop 36(6):1267–1273.  https://doi.org/10.1007/s00264-011-1474-5 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Wang G, Mao Z, Zhang L et al (2015) Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. J Orthop Surg Res 10:122.  https://doi.org/10.1186/s13018-015-0242-4 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Füchtmeier B, May R, Hente R et al (2007) Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants. Arch Orthop Trauma Surg 127(6):441–447.  https://doi.org/10.1007/s00402-007-0319-6 CrossRefPubMedGoogle Scholar
  35. 35.
    Gracitelli MEC, Malavolta EA, Assunção JH et al (2016) Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial. J Shoulder Elbow Surg 25(5):695–703.  https://doi.org/10.1016/j.jse.2016.02.003 CrossRefPubMedGoogle Scholar
  36. 36.
    Zhu Y, Lu Y, Shen J et al (2011) Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg Am 93(2):159–168.  https://doi.org/10.2106/JBJS.J.00155 CrossRefPubMedGoogle Scholar
  37. 37.
    Sun Q, Ge W, Li G et al (2018) Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. Int Orthop 42(3):641–650.  https://doi.org/10.1007/s00264-017-3683-z CrossRefPubMedGoogle Scholar
  38. 38.
    Lübbeke A, Rees JL, Barea C et al (2017) International variation in shoulder arthroplasty. Acta Orthop 88(6):592–599.  https://doi.org/10.1080/17453674.2017.1368884 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Antuña SA, Sperling JW, Cofield RH (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17(2):202–209.  https://doi.org/10.1016/j.jse.2007.06.025 CrossRefPubMedGoogle Scholar
  40. 40.
    Gallinet D, Ohl X, Decroocq L et al (2018) Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic review and meta-analysis. Orthop Traumatol Surg Res 104(6):759–766.  https://doi.org/10.1016/j.otsr.2018.04.025 CrossRefPubMedGoogle Scholar

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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