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How do surgeons decide when to treat proximal humerus fractures with operative versus nonoperative management?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study was to determine the underlying factors that drive the decision for surgeons to pursue operative versus nonoperative management for proximal humerus fractures (PHF) and if fellowship training had an impact on these decisions.

Methods

An electronic survey was distributed to members of the Orthopaedic Trauma Association and the American Shoulder and Elbow Surgeons Society to assess differences in patient selection for operative versus nonoperative management of PHF. Descriptive statistics were reported for all respondents.

Results

A total of 250 fellowship trained Orthopaedic Surgeons responded to the online survey. A greater proportion of trauma surgeons preferred nonoperative management for displaced PHF fractures in patients over the age of 70. Operative management was preferred for older patients with fracture dislocations (98%), limited humeral head bone subchondral bone (78%), and intraarticular head split (79%). Similar proportions of trauma surgeons and shoulder surgeons cited that acquiring a CT was crucial to distinguish between operative and nonoperative management.

Conclusion

We found that surgeons base their decisions on when to operate primarily on patient’s comorbidities, age, and the amount of fracture displacement when treating younger patients. Further, we found a greater proportion of trauma surgeons elected to proceed with nonoperative management in patients older than the age of 70 years old as compared to shoulder surgeons.

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Acknowledgements

The authors acknowledge the help of Julie Agel, ATC. The authors would like to acknowledge and thank all of the members of the OTA Evidence Based Quality, Value & Safety Committee: Alex Benedick, MD; Ryan K. Harrison, MD; Michael Leslie, DO; Anna N. Miller, MD; Gudrun E. Mirick, MD; William M. Reisman, MD. The authors would also like to acknowledge and thank all of the members of the ASES Multicenter Taskforce on Proximal Humerus Fractures: Joseph A. Abboud, M.D.; Luke S. Austin, M.D.; Jonathan D. Barlow, M.D.; N. Douglas Boardman III, M.D.; Kamal I. Bohsali, M.D.; Shannon R. Carpenter, M.D.; Patrick J. Denard, M.D.; Brody A. Flanagin, M.D.; Grant E. Garrigues, M.D.; Andrew Green, M.D.; Heinz R. Hoenecke Jr, M.D.; J. Gabriel Horneff III, M.D.; Joseph P. Iannotti, M.D.; Scott G. Kaar, M.D.; David Kovacevic, M.D.; John E. Kuhn, M.D.; Mark D. Lazarus, M.D.; Donald H. Lee, M.D.; David Kovavecik M.D.; Surena Namdari, M.D.; Gregory P. Nicholson, M.D.; E. Scott Paxton, M.D.; Brent A. Ponce, M.D.; Matthew L. Ramsey, M.D.; Gerald R. Williams, M.D

Funding

This study received no outside funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Alabama, 510 20th St South, Faculty Office Tower, Birmingham, AL, 35294, USA

    Logan A. Reed, David A. Patch, Joseph P. Johnson & Clay A. Spitler

  2. University of Florida College of Medicine, University of Florida, Gainesville, FL, USA

    Kevin A. Hao

  3. Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA

    Joseph J. King

  4. Cooper Bone and Joint Institute, Cooper Medical School at Rowan University, Camden, NJ, USA

    Catherine Fedorka

  5. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Jaimo Ahn

  6. Department of Orthopaedic Surgery, The University of Chicago, Chicago, IL, USA

    Jason A. Strelzow

  7. Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA

    Jonah Hebert-Davies

  8. Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Milton T. M. Little

  9. Department of Orthopaedic Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA

    Peter C. Krause

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  1. Logan A. Reed
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Corresponding author

Correspondence to Logan A. Reed.

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Conflict of interest

Joseph J. King is a consultant for Exactech, Inc. Catherine Fedorka is a consultant for Stryker. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Reed, L.A., Hao, K.A., Patch, D.A. et al. How do surgeons decide when to treat proximal humerus fractures with operative versus nonoperative management?. Eur J Orthop Surg Traumatol 33, 3683–3691 (2023). https://doi.org/10.1007/s00590-023-03610-1

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  • DOI: https://doi.org/10.1007/s00590-023-03610-1

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