title: Do Treatment Policies for Proximal Humerus Fractures Differ among Three Nordic Countries and Estonia? Results of a Survey Study.
abstract: OBJECTIVE
  Proximal humerus fractures are common fragility injuries. The incidence of these fractures has been estimated to be 82-105 per 105 person-years. Treatment of this fracture, especially in the elderly, is controversial. Our study group published a systematic review of the available literature and concluded that non-operative methods are favored over operative methods in three- and four-part fractures. The aim of this multinational study was to compare treatment policies for proximal humerus fractures among the Nordic countries and Estonia.
  
  
  METHODS
  The study was conducted as a questionnaire-based survey, using the Internet-based program, Webropol(®) (webropol.com). The questionnaire link was sent to the surgeons responsible for treating proximal humerus fractures in major public hospitals in Estonia, Finland, Norway, and Sweden. Questionnaire included questions regarding the responder's hospital, patient characteristics, and examinations taken before decision making. Clinical part included eight example patient cases with treatment options.
  
  
  RESULTS
  Of the 77 recipients of the questionnaire, 59 responded; consequently, the response rate was 77%. Based on the eight presented displaced fracture examples, in both Estonia and Norway and in Finland, 41% and 38%, respectively, preferred surgical treatment with locking plate. In Sweden, the percentage was 28%. The pre- and post-operative protocols showed a similarity in all participant countries.
  
  
  CONCLUSIONS
  Our survey revealed a remarkable uniformity in the current practice of operative treatments and rehabilitation for proximal humerus fractures in the participant countries.
authors.affiliation: Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland antti.launonen@pshp.fi.
authors.forename: A P
authors.initials: AP
authors.lastname: Launonen
authors.affiliation: Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland.
authors.forename: V
authors.initials: V
authors.lastname: Lepola
authors.affiliation: Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Laitinen
authors.affiliation: Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland.
authors.forename: V M
authors.initials: VM
authors.lastname: Mattila
mesh_terms: D001291:Attitude of Health Personnel; D004957:Estonia; D005592:Fracture Fixation / Q000379:methods* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012537:Scandinavian and Nordic Countries; D012784:Shoulder Fractures / Q000628:therapy*
keywords: Proximal; fracture; humerus; survey; treatment