Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012

Background Surgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population. Methods We retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated. Results Within the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume ( P = .119). The percentage of fractures treated surgically decreased significantly from 16.2% to 13.9% ( P