Müller Johanna E, Jussel Angela, Procter Emily, Brunner Ulrich H
Franz Tappeiner Hospital, Department of Orthopaedics and Traumatology, Merano, Italy.
Ludwig Maximilians University, Munich, Germany.
JSES Int. 2025 Mar 13;9(4):1015-1020. doi: 10.1016/j.jseint.2025.02.008. eCollection 2025 Jul.
Proximal humerus fractures (PHF) are one of the most common fractures in elderly patients, but consensus about optimal management is lacking. Conservative therapy has been recommended for elderly patients, though many countries report an increase in surgical procedures. There has also been a rapid increase in shoulder arthroplasty internationally, though large variation exists in the use of these procedures. The aim of this study was to compare the relative incidence of osteosynthesis of the proximal humerus and shoulder arthroplasty approximately over a decade in Germany, Austria, and Switzerland.
National statistics databases were searched for cases of osteosynthesis of the proximal humerus (2011-2019) and shoulder arthroplasty (2009-2019) in Germany, Austria, and Switzerland. Case retrieval was based on national operation codes. National census estimates were used to calculate incidence rates per person-year.
The relative incidence of osteosynthesis of the proximal humerus is 1.7 times higher in Germany than in Switzerland and Austria. The relative incidence did not increase in any country between 2011 and 2019. In Germany, osteosynthesis was performed for relatively more elderly patients of ≥70 years compared to the other 2 countries and relatively more female patients compared to Austria. The relative incidence of shoulder arthroplasty increased similarly in all 3 countries between 2009 and 2019. The largest increase was seen in patients of ≥70 years; in this group the incidence more than doubled over the 10-year period in both Switzerland and Austria. Shoulder arthroplasty was more common in Switzerland for patients of ≥40 years compared to the other countries (1.8 times higher on average). Fracture endoprostheses were more common in Germany compared to Switzerland (38% vs. 23% of all shoulder arthroplasties in 2017). Germany had a higher rate of surgical management of PHF, that is, both osteosynthesis and arthroplasty as a primary management strategy.
The overall trends of these procedures are similar in Germany, Austria, and Switzerland within the investigated period; however, some differences in surgical strategy could be identified, for example, reliance on osteosynthesis in elderly female patients with PHF in Germany.
肱骨近端骨折（PHF）是老年患者中最常见的骨折之一，但对于最佳治疗方法尚无共识。尽管许多国家报告手术治疗有所增加，但仍建议对老年患者采用保守治疗。国际上肩关节置换术也迅速增加，不过这些手术的使用存在很大差异。本研究的目的是比较德国、奥地利和瑞士近十年间肱骨近端接骨术和肩关节置换术的相对发生率。
在国家统计数据库中搜索德国、奥地利和瑞士肱骨近端接骨术（2011 - 2019年）和肩关节置换术（2009 - 2019年）的病例。病例检索基于国家手术编码。使用国家人口普查估计数计算每人每年的发病率。
德国肱骨近端接骨术的相对发生率比瑞士和奥地利高1.7倍。2011年至2019年期间，任何一个国家的相对发生率均未增加。在德国，与其他两个国家相比，接受接骨术的≥70岁老年患者相对较多，与奥地利相比，女性患者相对较多。2009年至2019年期间，所有三个国家肩关节置换术的相对发生率均有类似增加。≥70岁患者的增幅最大；在这组患者中，瑞士和奥地利在10年期间的发病率均增加了一倍多。与其他国家相比，≥40岁患者的肩关节置换术在瑞士更为常见（平均高1.8倍）。与瑞士相比，德国的骨折内置假体更为常见（2017年占所有肩关节置换术的38% vs. 23%）。德国肱骨近端骨折的手术治疗率较高，即接骨术和置换术均作为主要治疗策略。
在研究期间，德国、奥地利和瑞士这些手术的总体趋势相似；然而，可以确定一些手术策略上的差异，例如，德国老年女性肱骨近端骨折患者对接骨术的依赖。
