title: Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population.
abstract: BACKGROUND
  With an aging population, fragility fractures including injuries to the proximal humerus continue to rise in the United States. The purpose of this study was to investigate recent trends in the incidence and treatment of proximal humerus fractures (PHFs) in a cross-sectional elderly population.
  
  
  METHODS
  Medicare data from 2005 to 2012 were queried to identify patients treated for PHF. Associated patient demographics, hospitalization data, treatment, and revision status were obtained. Statistical analyses were performed to identify significant trends in treatment.
  
  
  RESULTS
  There were 259,506 PHFs recorded, with 79% occurring in female patients. In all age groups, nonoperative treatment of PHF was the most common method (67%). Within the surgical group, open reduction with internal fixation was most frequently used, and total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) was the least common (11%). However, although the overall rate of surgical intervention remained constant, there was a significant increase in treatment with TSA from 3% in 2005 to 17% in 2012. In particular, RTSA represented 89% of all TSAs for PHF in 2011. All surgical treatment options demonstrated high 2-year survival rates without revision surgery (97%).
  
  
  CONCLUSIONS
  Recent trends show that in the elderly population, nonoperative management remains the most common treatment for PHFs. Within the surgically treated cohort, there has been an increase in treatment with arthroplasty including RTSA, with a low rate of early revisions. There are excellent survival rates in all surgically treated PHFs, but long-term data will be required to fully evaluate the viability of these surgical options.
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Han
authors.affiliation: School of Medicine, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Sing
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Feeley
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: C Benjamin
authors.initials: CB
authors.lastname: Ma
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA. Electronic address: alan.zhang@ucsf.edu.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Zhang
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D012086:Reoperation / Q000706:statistics & numerical data; D017678:Sex Distribution; D012784:Shoulder Fractures / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Medicare database; Proximal humerus fracture; fragility fracture; hemiarthroplasty; internal fixation; shoulder arthroplasty