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

  • Trauma Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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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.

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Author notes

  1. Alexander Klug and Yves Gramlich contributed equally to this publication.

Authors and Affiliations

  1. Zentrum für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Germany

    Alexander Klug, Yves Gramlich, Dennis Wincheringer & Reinhard Hoffmann

  2. Orthopaedicum Wiesbaden, Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Friedrichstrasse 29, 65185, Wiesbaden, Germany

    Kay Schmidt-Horlohé

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Klug, A., Gramlich, Y., Wincheringer, D. et al. Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg 139, 1713–1721 (2019). https://doi.org/10.1007/s00402-019-03252-1

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