European Journal of Orthopaedic Surgery & Traumatology

, Volume 21, Issue 8, pp 569–578

Racial differences in type of surgical procedure performed for proximal humerus fractures

  • Nitin B. Jain
  • Laurence D. Higgins
  • Elena Losina
  • Ricardo Pietrobon
  • Jeffrey N. Katz
Original Article

DOI: 10.1007/s00590-011-0762-5

Cite this article as:
Jain, N.B., Higgins, L.D., Losina, E. et al. Eur J Orthop Surg Traumatol (2011) 21: 569. doi:10.1007/s00590-011-0762-5

Abstract

Background

Proximal humeral fracture constitutes a medical emergency on most occasions in which the decision to perform either open reduction and internal fixation (ORIF) or hemiarthroplasty is determined by the operating surgeon. Hemiarthroplasty is a more expensive and technically challenging procedure that requires compliance with rigorous and prolonged rehabilitation postsurgically. We assessed whether racial differences exist in utilization of hemiarthroplasty versus ORIF in patients with proximal humeral fracture.

Methods

Patients with primary diagnosis of closed proximal humeral fracture undergoing either hemiarthroplasty or ORIF were selected from Nationwide Inpatient Sample databases for 1990–2000 (n = 10,306).

Results

Among white patients with proximal humeral fracture, 35.3% underwent hemiarthroplasty when compared with 17.2% of black and 26.9% of Hispanic patients (P < 0.001). Results of multivariate analysis adjusted for age, sex, hospital volume, year, and site of fracture on proximal humerus confirmed that black patients were less likely to undergo hemiarthroplasty when compared with white patients (OR = 0.76; 95% CI = 0.54, 1.08).

Conclusions

Our findings are consistent with studies documenting racial differences in utilization of elective orthopedic procedures. Given that humeral fracture is an emergency on most occasions, and our data suggest that differences in utilization more likely reflect surgeons’ operative decisions than patient preferences. We cannot ascertain whether differential procedure utilization is clinically justified. Further studies are needed to confirm whether surgeons’ operative decisions are a factor in the differential utilization of arthroplasty procedures by race and to understand outcomes and indications for ORIF and hemiarthroplasty, especially in black patients.

Keywords

Proximal humeral fracturesRacial differencesHemiarthroplasty

Supplementary material

590_2011_762_MOESM1_ESM.pdf (182 kb)
Supplementary material 1 (pdf 182 kb)

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Nitin B. Jain
    • 1
  • Laurence D. Higgins
    • 2
  • Elena Losina
    • 2
    • 4
    • 5
  • Ricardo Pietrobon
    • 3
  • Jeffrey N. Katz
    • 2
    • 4
  1. 1.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Orthopaedic Surgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of Orthopaedic SurgeryDuke University Medical CenterDurhamUSA
  4. 4.Section of Clinical Sciences, Division of Rheumatology, Immunology, and AllergyBrigham and Women’s HospitalBostonUSA
  5. 5.Department of BiostatisticsBoston University School of Public HealthBostonUSA