Roivas Ida A, Leino Oskari K, Lehtimäki Kaisa K, Matilainen Markus, Ekman Elina
Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
J Shoulder Elbow Surg. 2025 Apr;34(4):1081-1087. doi: 10.1016/j.jse.2024.08.027. Epub 2024 Oct 11.
Proximal humeral fractures (PHFs) are one of the most common fragility fractures and there is accumulating evidence that even displaced PHFs should be treated conservatively. The treatment should be as effective and standardized as possible regardless of the hospital district of the patient. The aim of this study was to describe possible regional variation in incidence and treatment methods of PHFs in Finland.
The study included all Finnish inhabitants aged 16 years and older with PHF diagnosis between 1997 and 2019. All records are based on data from 2 national registers. The fractures and operations were organized according to hospital district of the patient and annual incidences of PHFs, and different treatment methods were calculated for each hospital district.
Between 1997 and 2019, 79,053 PHFs were identified. 64,117 of PHFs were treated conservatively and 14,936 operatively. The incidence of conservative treatment corresponded closely to the fracture incidence per hospital district. Internal fixation incidence generally increased toward the end of the first half of the study period and declined thereafter, and hemiarthroplasty was replaced by total shoulder arthroplasty as the most common type of arthroplasty by the end of the period. We found regional variation in the incidence of PHFs, with a low of 61.4 per 10 in Åland, and a high of 97.7 per 10 in East-Savo.
In Finland, the treatment of PHFs did not differ fundamentally between hospital districts and a general evidence-based shift in treatment practice was shown. We found regional variation in the incidence of PHFs, and it seems that the higher incidence of PHFs is concentrated in Eastern Finland.
肱骨近端骨折（PHF）是最常见的脆性骨折之一，越来越多的证据表明，即使是移位的PHF也应采用保守治疗。无论患者所在的医院区域如何，治疗都应尽可能有效且标准化。本研究的目的是描述芬兰PHF发病率和治疗方法可能存在的地区差异。
该研究纳入了1997年至2019年间所有年龄在16岁及以上且诊断为PHF的芬兰居民。所有记录均基于两个国家登记处的数据。根据患者所在的医院区域和PHF的年发病率对骨折和手术进行整理，并计算每个医院区域的不同治疗方法。
1997年至2019年间，共确诊79,053例PHF。其中64,117例采用保守治疗，14,936例采用手术治疗。保守治疗的发生率与每个医院区域的骨折发生率密切相关。内固定发生率在研究期前半期结束时总体呈上升趋势，此后下降，到研究期末，半关节置换术被全肩关节置换术取代，成为最常见的关节置换类型。我们发现PHF发病率存在地区差异，奥兰群岛每10万人中发病率低至61.4例，东萨沃每10万人中发病率高至97.7例。
在芬兰，各医院区域之间PHF的治疗方法没有根本差异，并且在治疗实践中显示出基于一般证据的转变。我们发现PHF发病率存在地区差异，似乎较高的PHF发病率集中在芬兰东部。
