Cooke Hayden L, Gabig Andrew M, Karzon Anthony L, Hussain Zaamin B, Ojemakinde Akinade A, Wagner Eric R, Gottschalk Michael B
Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
JSES Rev Rep Tech. 2023 Mar 31;4(2):146-152. doi: 10.1016/j.xrrt.2023.02.009. eCollection 2024 May.
Proximal humerus fractures are the third most common fracture type for patients between the ages of 65 and 89 and occur more frequently in women than men. Given the variety of surgical treatments for proximal humerus fractures, the aim of this study was to (1) report United States national volume and incidence estimates for surgical management of proximal humerus fractures to better understand the changing practice over the past decade and (2) to analyze differences in volume and incidence among age groups, sex, and geographic region.
Using IBM Marketscan national database, all patients that underwent open reduction internal fixation (ORIF), hemiarthroplasty, or reverse total shoulder arthroplasty (RTSA) between 2010 and 2019 were identified with Current Procedural Terminology codes. The dataset was further stratified to identify patients treated for proximal humerus fractures. IBM Marketscan provided discharge weights that were used to determine estimated national annual volumes of each procedure in IBM SPSS Statistics software (IBM Corp., Armonk, NY, USA). Volume and incidence were adjusted per 1,000,000 persons and calculated for subgroups according to age group, sex, and geographical region. The United States Census Bureau annual population data was used for all incidence calculations.
Over the past decade, the total volume and incidence of surgically treated proximal humerus fractures increased by 13% and 5%, respectively. Although overall incidence decreased, ORIF remained the most common surgical treatment. The greatest decrease in volume and incidence of ORIF occurred in patients ≥75. The incidence of ORIF treatment increased in the South and West while it decreased in the Northeast and Midwest. Total volume and incidence of HA decreased between 2010 and 2019 and this trend remained among all subgroups. Total volume and incidence of RTSA increased by over 300%. The incidence of males and females receiving RTSA increased by 266% and 320%, respectively. Volume and incidence of RTSA increased across all age groups. Volume and incidence of RTSA increased in the Midwest, South, and Western regions while it remained unchanged in the Northeast.
Surgical management trends of proximal humerus fractures have changed greatly over the past decade. ORIF remains the most common surgical treatment for proximal humerus fractures. HA has fallen out of favor while RTSA has seen significant increases in usage across sex, age groups, and geographic regions. These trends represent a change in practice for treating proximal humerus fractures by considering all patient and fracture characteristics when opting for surgical management.
肱骨近端骨折是65至89岁患者中第三常见的骨折类型，且在女性中比男性更频繁发生。鉴于肱骨近端骨折的手术治疗方式多样，本研究的目的是：（1）报告美国肱骨近端骨折手术治疗的全国手术量和发病率估计值，以更好地了解过去十年间不断变化的治疗方式；（2）分析不同年龄组、性别和地理区域之间在手术量和发病率上的差异。
使用IBM Marketscan全国数据库，通过当前程序术语代码识别出2010年至2019年间接受切开复位内固定术（ORIF）、半关节置换术或反式全肩关节置换术（RTSA）的所有患者。数据集进一步分层以识别接受肱骨近端骨折治疗的患者。IBM Marketscan提供出院权重，用于在美国IBM SPSS Statistics软件（IBM公司，美国纽约州阿蒙克）中确定每种手术的估计全国年度手术量。手术量和发病率按每100万人进行调整，并根据年龄组、性别和地理区域计算亚组数据。美国人口普查局的年度人口数据用于所有发病率计算。
在过去十年中，手术治疗的肱骨近端骨折的总手术量和发病率分别增加了13%和5%。尽管总体发病率下降，但ORIF仍然是最常见的手术治疗方式。ORIF手术量和发病率下降幅度最大的是≥75岁的患者。ORIF治疗的发病率在南部和西部有所增加，而在东北部和中西部则有所下降。2010年至2019年间，半关节置换术（HA）的总手术量和发病率下降，且这一趋势在所有亚组中均存在。RTSA的总手术量和发病率增加了300%以上。接受RTSA治疗的男性和女性的发病率分别增加了266%和320%。RTSA的手术量和发病率在所有年龄组中均有所增加。RTSA的手术量和发病率在中西部、南部和西部地区增加，而在东北部保持不变。
在过去十年中，肱骨近端骨折的手术治疗趋势发生了很大变化。ORIF仍然是肱骨近端骨折最常见的手术治疗方式。HA已失宠，而RTSA在性别、年龄组和地理区域的使用上均显著增加。这些趋势代表了在选择手术治疗时，通过考虑所有患者和骨折特征来治疗肱骨近端骨折的治疗方式的变化。
