Treatment Patterns of ABOS part II Candidates: A Decline of Operative Management Among Geriatric Proximal Humerus Fractures Over the Decade (2010-2020)

•The volume of operatively managed geriatric proximal humerus fractures between 2010 and 2020 decreased among ABOS part II candidates.•The rates of shoulder arthroplasty for proximal humerus fractures also decreased between 2010 and 2020.•The rates of shoulder arthroplasty versus open reduction internal fixation varied based on orthopaedic surgeons’ subspecialty fellowship training.•The rates of arthroplasty versus open reduction internal fixation had US geographic reginal differences, with the Southeast least likely to perform an arthroplasty as compared to the Midwest or Northeast. The purpose of this study was to assess trends in ABOS part II candidate's operative management of geriatric (≥65 years) proximal humerus fractures over the 2010-2020 decade. This retrospective database cohort study utilized the American Board of Orthopaedic Surgery (ABOS) database for candidates taking Part II of their boards. Surgical coding was reviewed and the ICD10 data was correlated to the CPT code for shoulder arthroplasty or open reduction internal fixation. We investigated the number of proximal humerus fracture operative cases per year, the percent arthroplasty used per year, the stratification of percent arthroplasty per orthopaedic fellowship subspecialty and geographic region. A total of 2409 operative cases for proximal humerus fractures in patients 65 years of age and older were submitted by 1,420 ABOS candidates. There was a 37% reduction in operatively managed proximal humerus fractures among ABOS part II candidates between the first half of the decade (2010-2015, 263.2 +/- 13.4) and the second half of the decade (2016-2020, 166 +/- 31.2; p