Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly.

摘要: Proximal humeral fractures account for 4% to 5% of all fractures, with only hip and distal radial in the elderly being more common. Humeral often require hospitalization and/or rehabilitation care1-6. While most proximal are minimally displaced can be treated nonoperatively, treatment is controversial includes nonoperative management, percutaneous fracture fixation, open reduction internal fixation (ORIF), arthroplasty7-13. The recent development locking plate technology has expanded indications ORIF certain types, especially those osteoporotic bone14. Advances techniques pinning have been used effectively adequate bone stock. Shoulder elbow fellowships rapidly recently, as well. To date, there no prospective randomized studies that determined which achieves best outcome elderly15. There marked variation rates orthopaedic surgical procedures among different geographic regions United States5,16-18. degree regional variability correlates inversely level scientific evidence consensus medical community regarding appropriate care a given condition17,19. Interventions strong base enjoy community, such antibiotic administration serious infection or exhibit minimal treatment20. On other hand, without high-quality literature supporting treatment, lumbar spine fusion, wide regionally17. Because poor on optimal we hypothesized would significant management. If management exists, compelling argument additional research funding needed conduct determine Medicare patients so achieved. The study current practice patterns important common conditions because these public health issues. As population aging, fragility becoming greater burden health-care system. Clinically, it know what odds repeat surgery after initial counsel accurately. results surgery, increased cost morbidity may considered determining patient absence data support one technique over another. Furthermore, if increasing time, this should studied. The specific aims were (1) incidence States both nationally regionally, (2) (3) compare revision head replacement. Our hypothesis was percentage surgically had years expansion led an rate surgery. We chose look at 1999 2000 them 2004 2005 plates introduced between time periods.