Related Experiment Video
Updated: Jun 12, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Surgeon-related Factors in the Surgical Treatment of Proximal Humerus Fractures
Kyong S Min1, Joshua Radi, Henry Fox
1From the Madigan Army Medical Center, Honolulu, Hawaii (Dr. Min); the Massachusetts General Hospital, Boston, MA (Dr. Min, Dr. Fox, Dr. Chang, Dr. Waryasz, and Dr. Chen); and the John A Burns School of Medicine, Honolulu, Hawaii (Dr. Min, and Dr. Radi).
Introduction:
In this study, we reviewed proximal humeral fractures surgically treated with open reduction and internal fixation (ORIF) to test the null hypothesis that there is no association between fracture characteristics and surgeon characteristics in outcomes after surgical management of displaced proximal humeral fractures with ORIF.
Methods:
A retrospective review of surgically treated proximal humeral fractures was done at a tertiary-level hospital. The data were organized into two categories: fracture characteristics and surgeon characteristics.
Results:
There were 314 proximal humeral fractures treated with ORIF. In total, there were 112 failures (36%). Bivariate Pearson correlations demonstrated that the number of proximal humerus fixation surgeries performed by an individual surgeon was associated with adequate calcar reduction (r = 0.995, P < 0.001) and greater tuberosity reduction (r = 0.994, P < 0.001). Years of experience was positively associated with adequate calcar reduction (r = 0.594, P = 0.012) and greater tuberosity reduction (r = 0.589, P = 0.013). Regression analysis of two surgeons versus the rest of the cohort demonstrated significantly lower failure rates (P = 0.001).
Discussion:
Complex proximal humeral fractures (3-part and 4-part) have better calcar reduction and tuberosity reduction when treated by surgeons with greater volume of proximal humeral fracture surgery. Among surgeons with high volume, there may be individuals who have the unique ability to provide markedly better results.
