ArticleJournal of shoulder and elbow surgery2014
Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus.
Article in Journal of shoulder and elbow surgery, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Comparison between arthroplasty and non-operative treatment for proximal humeral fractures: a systematic review and meta-analysis.Frontiers in medicine · 2024Pooled it
- Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol.BMC musculoskeletal disorders · 2018Trial
- Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures.BMC musculoskeletal disorders · 2017Trial
- Mortality in patients over 65 with proximal humerus fractures: a systematic review of 414,379 shoulders with meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- Predictive prognostic factors in patients with proximal humeral fracture treated with reverse shoulder arthroplasty.Shoulder & elbow · 2024Article
- Factors affecting hospital admission, hospital length of stay and new discharge destination post proximal humeral fracture: a retrospective audit.BMC geriatrics · 2024Article
- The Arterial Axis Lesions in Proximal Humeral Fractures-Case Report and Literature Review.Journal of personalized medicine · 2023Article
- Proximal Humerus Fractures in the Elderly U.S. Population: A Cross-Sectional Study of Treatment Trends and Comparison of Complication Rates after Joint Replacement, Open Reduction and Internal Fixation, and Non-Surgical Management.Journal of clinical medicine · 2023Article
- Clinical outcomes and structural integrity rate of arthroscopic augmented rotator cuff repairs using extracellular porcine matrix patch.Shoulder & elbow · 2022Article
- The Surgical Treatment of Proximal Humeral Fractures in Elderly Patients.Deutsches Arzteblatt international · 2021Article
- Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2021Article
- Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice.Musculoskeletal surgery · 2021Article
- A case of simultaneous bilateral reverse shoulder arthroplasty for bilateral comminuted proximal humerus fractures in an elderly patient.JSES international · 2021Article
- Can We Stratify Quality and Cost for Older Patients With Proximal and Midshaft Humerus Fractures?Geriatric orthopaedic surgery & rehabilitation · 2021Article
- Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus.BMJ (Clinical research ed.) · 2020Article
- Clinical results of reverse shoulder arthroplasty for comminuted proximal humerus fractures in elderly patients: a comparison between nonporous stems versus trabecular metal stems.JSES international · 2020Article
- Low risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures.JSES international · 2020Article
- ORIF versus arthroplasty for open proximal humerus fractures: Nationwide Inpatient Sample data between 1998 and 2013.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2018Article
- Predictors of Mortality in Elder Patients With Proximal Humeral Fracture.Geriatric orthopaedic surgery & rehabilitation · 2018Article
- Trends in incidence of proximal humerus fractures, surgical procedures and outcomes among elderly hospitalized patients with and without type 2 diabetes in Spain (2001-2013).BMC musculoskeletal disorders · 2017Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThis study tests the null hypothesis that, among patients aged 65 and older admitted to a United States hospital with an isolated fracture of the proximal humerus (no other injuries or fractures), there are no differences between operative (fixation or arthroplasty) and nonoperative treatments with respect to inpatient adverse events, inpatient mortality, and discharge to a long-term care facility rates accounting for comorbidities.
methodsUsing a large national database representing an estimated 132,005 patients aged 65 and older admitted to a US hospital with an isolated proximal humerus fracture between 2003 and 2007. Sixty-one percent did not have surgery, 22% were treated with open reduction and internal fixation (ORIF), and 17% were treated with arthroplasty.
resultsThe risk of an in hospital adverse event was 21% overall and was 4.4 times greater with arthroplasty and 2.7 times greater with ORIF compared to nonoperative treatment. The risk of in hospital death was 1.8% overall and was 2.8 times greater with ORIF compared to nonoperative treatment. Patients treated operatively were less likely to be discharged to a long-term facility compared to patients treated nonoperatively.
conclusionIn spite of a tendency to treat the most infirm patients (those that are not discharged to home) nonoperatively, operative treatment (open reduction and internal fixation in particular) is an independent risk factor for inpatient adverse events and mortality in older-aged patients admitted to the hospital with an isolated fracture of the proximal humerus and should perhaps be offered more judiciously. LEVEL OF EVIDENCE: Level III, retrospective cohort study, treatment study.
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Registered trials
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