title: National trends in proximal humerus fracture treatment patterns.
abstract: BACKGROUND
  The treatment of proximal humerus fractures (PHF) is largely surgeon dependent with no clear guidelines for selecting the optimal method of treatment.
  
  
  OBJECTIVE
  The aim of this study was to evaluate trends and variations in treatment methods of PHF in the United States from 2004 to 2012 and to determine the regional differences in treatment.
  
  
  METHODS
  The National Inpatient Sample was used to identify all patient discharges with diagnosis codes for PHF and the data were classified based on ICD-9 procedure codes. Patient and hospital demographics were also analyzed. Simple linear regression analyses were performed for each treatment modality to evaluate current treatment trends and to extrapolate the future trends of PHF treatment over the next 20 years.
  
  
  RESULTS
  A national estimate of 550,116 PHF discharges was identified over the time period. Significant correlations between change over time and treatment modality were found for reverse shoulder arthroplasty (RSA) (r = 0.903, p < 0.001), open reduction internal fixation (r = 0.876, p = 0.002), and closed reduction internal fixation (r = -0.922, p < 0.001). The RSA regression model showed that by the year 2032, PHF treated with RSA will increase 100% from 2012.
  
  
  CONCLUSIONS
  There were significant changes in treatment modalities for PHF from 2004 to 2012; The projected number of RSA used to treat PHF will be about 9115 in 2032, compared to 340 in 2004.
  
  
  CONCLUSIONS
  Overall, there was a growth in proximal humerus fractures treated in an inpatient setting in the United States. RSA had the greatest proportional increase over time, but only accounted for less than 2% of total interventions.
authors.affiliation: Department of Orthopaedic Surgery, Wayne State University/Oakwood, 10000 Telegraph Road, Taylor, MI, 48180, USA. sabes001@gmail.com.
authors.forename: Vani J
authors.initials: VJ
authors.lastname: Sabesan
authors.affiliation: Department of Orthopaedic Surgery, Wayne State University/Oakwood, 10000 Telegraph Road, Taylor, MI, 48180, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lombardo
authors.affiliation: Department of Orthopaedic Surgery, Wayne State University/Oakwood, 10000 Telegraph Road, Taylor, MI, 48180, USA.
authors.forename: Graysen
authors.initials: G
authors.lastname: Petersen-Fitts
authors.affiliation: Department of Orthopaedic Surgery, Wayne State University/Oakwood, 10000 Telegraph Road, Taylor, MI, 48180, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Weisman
authors.affiliation: Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI, 48201, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Ramthun
authors.affiliation: Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI, 48201, USA.
authors.forename: James
authors.initials: J
authors.lastname: Whaley
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data* / Q000639:trends*; D000070628:Closed Fracture Reduction / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data* / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: National inpatient sample (NIS); Proximal humerus fracture; Reverse shoulder arthroplasty; Total shoulder arthroplasty; Treatment patterns