Cheesman J Sam, Englert Calvin H, Yang Qian, Yoo Jung U, Nazir Omar F, Mirarchi Adam J
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
OHSU-PSU School of Public Health, Portland, OR, USA.
Shoulder Elbow. 2025 Jul 16:17585732251359178. doi: 10.1177/17585732251359178.
PROximal Fracture of the Humerus Evaluation by Randomization (PROFHER) was a randomized control trial (RCT) published in 2015 comparing outcomes of operative versus nonoperative treatment of proximal humerus fractures (PHFs), finding no difference in Oxford Shoulder Scores between operative and nonoperative groups at 2 and 5 years. This study investigated changes in PHF treatment patterns by American orthopedic surgeons after the publication of PROFHER in 2015.
Using the PearlDiver database, patients aged 16 years or older with closed PHFs without associated dislocation or pathologic fracture etiology between 2011 and 2019 were identified. Patients who underwent operative treatment, including open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), and hemiarthroplasty, were identified via current procedural terminology (CPT) codes. Data were analyzed using simple linear regression and piecewise linear regression to assess changes in rates of surgical management of PHFs starting in 2015.
Simple linear regression analysis showed increases in total operative treatment, with increased rates of ORIF and TSA; hemiarthroplasty rates decreased. Piecewise linear regression showed no significant change in the rate of treatment per year after 2015 for total operative treatment, ORIF, or TSA.
PROFHER did not significantly impact rates of operative treatments for PHFs in the United States.
Level III; Retrospective Case-Control Design Using Large Database; Prognosis Study.
肱骨近端骨折随机评估（PROFHER）是一项于2015年发表的随机对照试验（RCT），比较了肱骨近端骨折（PHF）手术治疗与非手术治疗的结果，发现在2年和5年时，手术组和非手术组的牛津肩部评分没有差异。本研究调查了2015年PROFHER发表后美国骨科医生对PHF治疗模式的变化。
使用PearlDiver数据库，确定2011年至2019年间年龄在16岁及以上、闭合性PHF且无相关脱位或病理性骨折病因的患者。通过当前程序术语（CPT）代码识别接受手术治疗的患者，包括切开复位内固定（ORIF）、全肩关节置换术（TSA）和半关节置换术。使用简单线性回归和分段线性回归分析数据，以评估从2015年开始PHF手术治疗率的变化。
简单线性回归分析显示，总体手术治疗增加，ORIF和TSA的发生率增加；半关节置换术的发生率下降。分段线性回归显示，2015年后，总体手术治疗、ORIF或TSA的每年治疗率没有显著变化。
PROFHER对美国PHF的手术治疗率没有显著影响。
III级；使用大型数据库的回顾性病例对照设计；预后研究。
