Changing Demographic and Treatment Trends of Proximal Humerus Fractures: A TriNetX Analysis of 74,781 Patients

As the US population continues to age and diversify, so have treatment strategies for proximal humerus fractures (PHFs). The primary hypothesis of this study is that PHFs are increasing in prevalence with an associated increase in the rate of its surgical management.

The TriNetX US Collaborative Network database was queried for all patients diagnosed with PHFs between 2016 and 2022. Current Procedural Terminology codes were used to group patients into cohorts based on surgical versus nonsurgical treatment. Incidence and treatment rate differences were analyzed between demographic groups such as age, sex, and ethnicity.

A total of 74,781 PHFs were identified and analyzed between 2016 and 2022. The average overall PHF surgical incidence rate between 2016 and 2022 was 10.5%. Open reduction and internal fixation (ORIF) was the most common surgical treatment (68.5%). Overall utilization of total shoulder arthroplasty (TSA/rTSA) surgical techniques increased from 2016 to 2022 for all fracture types (P < 0.0001), while ORIF (P = 0.0079) and hemiarthroplasty (P = 0.0432) utilization decreased. Women were less likely to undergo surgical treatment than men (odds ratio [OR], 0.9490; P < 0.05). White patients were more likely to receive surgical treatment than Black (OR, 0.7688; P < 0.0001) and Asian patients (OR, 0.7770; P = 0.0043).

Surgical management strategies have changed with TSA/rTSA becoming more frequently used for all fracture types with a decline in the utilization of ORIF and hemiarthroplasty. This study suggests a shift in surgical treatment strategies between 2016 and 2022, and reflects increased utilization of arthroplasty procedures for fracture management.