title: The factors influencing the decision making of operative treatment for proximal humeral fractures.
abstract: BACKGROUND
  The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations.
  
  
  METHODS
  A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment.
  
  
  RESULTS
  Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture mechanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon.
  
  
  CONCLUSIONS
  Patient information-older age in particular-is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michiel G J S
authors.initials: MG
authors.lastname: Hageman
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Jayakumar
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: King
authors.affiliation: Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Guitton
authors.affiliation: Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
authors.affiliation: Yawkey Center, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dring@partners.org.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D001178:Arthroplasty; D019643:Arthroplasty, Replacement; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000523:psychology; D015203:Reproducibility of Results; D012784:Shoulder Fractures / Q000601:surgery*
keywords: Proximal humeral fractures; decision-making; factors; operative versus nonoperative treatment