title: Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures.
abstract: OBJECTIVE
  Proximal humeral fractures are common and frequently associated with osteoporosis. Little is known about the association between the patho-anatomical fracture pattern of proximal humeral fractures and patient characteristics. The purpose of this six year longitudinal registry analysis of proximal humeral fractures was to study overall numbers, certain predefined pathoanatomical patterns and distribution compared with specific patient characteristics.
  
  
  METHODS
  Data of patients treated between 2006 and 2011 in a country hospital that provides care >95 % of the city's hospitalised patients with fractures was retrospectively reviewed. Data were analysed according to patient characteristics of age, gender, comorbidity, accompanying injuries and radiological analysis of pathoanatomical fracture patterns based on Neer and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification.
  
  
  RESULTS
  Eight hundred and fifteen proximal humeral fractures (67% women/33% men; mean age 66 years, range 19-99) were analysed. During the study period, an overall increase of 42.5% was found: according to AO classification, 46% were type A, 22% type B and 32% type C. Based on the Neer classification, 86% were displaced, and 49% were complex with more than three parts. Of complex fractures, 57% were female patients >60 years. The number of complex fractures was five times higher in women >60 years than in men of the same age group.
  
  
  CONCLUSIONS
  An overall increase of inpatients with displaced proximal tibial fractures was documented. Interestingly, complex displaced proximal humeral fractures, especially in older women with comorbidities, accounted for the majority of cases. These results suggest that health-care planning and hospital-based therapeutic strategies should focus on this patient group.
authors.affiliation: Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard-Karls University Tübingen, Schnarrenbergstr, 95, 72074, Tübingen, Germany, C.Bahrs@gmx.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Bahrs
authors.forename: Tanja
authors.initials: T
authors.lastname: Stojicevic
authors.forename: Stojicevic
authors.initials: S
authors.lastname: Tanja
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.forename: Blumenstock
authors.initials: B
authors.lastname: Gunnar
authors.forename: Stig
authors.initials: S
authors.lastname: Brorson
authors.forename: Brorson
authors.initials: B
authors.lastname: Stig
authors.forename: Andreas
authors.initials: A
authors.lastname: Badke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.forename: Stöckle
authors.initials: S
authors.lastname: Ulrich
authors.forename: Bernd
authors.initials: B
authors.lastname: Rolauffs
authors.forename: Rolauffs
authors.initials: R
authors.lastname: Bernd
authors.forename: Thomas
authors.initials: T
authors.lastname: Freude
authors.forename: Freude
authors.initials: F
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D012784:Shoulder Fractures / Q000145:classification / Q000453:epidemiology* / Q000473:pathology*