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

Abstract

Background and purpose: Proximal 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 methods: Data 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.Results: We 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.Interpretation: The 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.

Fibula allograft in complex three-part and four-part proximal humeral fractures in active patients, a matched case-control study

“…One might argue that matching should have been performed on sex. However, since osteoporosis occurs at a higher age and more often in women, 6 in these relatively young patients sex was not a criterium. According to the complexity and potential implications of osteonecrosis we might have considered a longer follow-up period (eg, 2 years).…”

Unchanged incidence but change in treatment trends from 1996 to 2018: 23,718 humeral shaft fractures from the Danish National Patient Registry

“…This may be caused by the increased risk of shoulder complaints with an antegrade humeral nail, but no clinically relevant risk differences have been demonstrated between the implants [25]. Furthermore, this shift in implant preference may be closely linked to technological advancements with the introduction of locking plates in the early 2000s, corresponding to a period of increased plate usage as seen in other studies [26,27], underlining the role of innovation in driving this shift in implant preference.…”

Long-term survival of resurfacing humeral hemiarthroplasty

“…Currently, the most popular shoulder implant systems are total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) [1,5,8]. The fourth type of implant is hemiarthroplasty (HA), which is mainly used to treat a fragmented proximal humerus fracture [10].…”

“…In addition, RHHIs have been associated with low complication rates [3][4][5][7][8][9]. Moreover, if the RHHI fails, revision surgery can be easily achieved by a revision to a stemless reverse prosthesis, as the bone stock has been maintained, no cement or stem must be exposed and removed, and no loss of length will be encountered [8,10]. However, bone stock alterations are common after TSA and complicate revision surgery, which may affect the revision threshold level.…”