title: Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012.
abstract: BACKGROUND
  Surgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population.
  
  
  METHODS
  We retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated.
  
  
  RESULTS
  Within the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume (P = .119). The percentage of fractures treated surgically decreased significantly from 16.2% to 13.9% (P < .001). The utilization rate decreased significantly for HA from 52% to 39% (P < .001), increased significantly for RSA from 11% to 28% (P < .001), and did not change significantly for ORIF (P = .164). The utilization rate of RSA nearly tripled for patients older than 65 years (11% to 29%) and doubled for patients younger than 65 (6% to 12%).
  
  
  CONCLUSIONS
  From 2009 to 2012, utilization rates of ORIF remained fairly constant. HA remains the most commonly used surgical treatment for proximal humeral fractures in the Medicare population, but its use has declined significantly. This decline has been offset by a corresponding increase in RSA.
authors.affiliation: Holy Cross Orthopedic Research Institute, Fort Lauderdale, FL, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rosas
authors.affiliation: Holy Cross Orthopedic Research Institute, Fort Lauderdale, FL, USA.
authors.forename: Tsun Yee
authors.initials: TY
authors.lastname: Law
authors.affiliation: Holy Cross Orthopedic Research Institute, Fort Lauderdale, FL, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kurowicki
authors.affiliation: Shoulder and Elbow Department, Holy Cross Hospital, Fort Lauderdale, FL, USA.
authors.forename: Nate
authors.initials: N
authors.lastname: Formaini
authors.affiliation: Trauma and Arthroplasty Service, University of Miami Health System, Miami, FL, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kalandiak
authors.affiliation: Shoulder and Elbow Department, Holy Cross Hospital, Fort Lauderdale, FL, USA. Electronic address: jonlevy123@yahoo.com.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data / Q000639:trends*; D062785:Hemiarthroplasty / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000453:epidemiology / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Proximal humeral fractures; hemiarthroplasty; reverse shoulder arthroplasty; total shoulder arthroplasty