ArticleInternational orthopaedics2015
Decision making in displaced fractures of the proximal humerus: fracture or surgeon based?
Article in International orthopaedics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Pooled it
- Influence of age, gender, and radiographic features on the deltoid splitting approach for surgical osteosynthesis in displaced proximal humerus fractures: a comparison study.BMC musculoskeletal disorders · 2017Trial
- Plate osteosynthesis versus non-surgical treatment in displaced proximal humerus fractures-long term functional outcome and quality of life.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Mid- to long-term outcomes of proximal humerus fractures treated with open reduction, plate fixation, and iliac bone autograft augmentation.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2024Article
- Inter-rater agreement among shoulder surgeons on treatment options for proximal humeral fractures among shoulder surgeons.Clinics in shoulder and elbow · 2022Article
- Comparison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age.Cureus · 2021Article
- Intra- and interobserver reliability for predicting hip preservation versus hip arthroplasty utilizing plain radiographs with comparison of surgeon specialization.Journal of hip preservation surgery · 2020Article
- Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults.JMIR mHealth and uHealth · 2018Article
- Orthopaedic surgeons' opinions surrounding the management of proximal humerus fractures: an international survey.International orthopaedics · 2017Article
- Numerical investigation of fracture impaction in proximal humeral fracture fixation with locking plate and intramedullary nail.International orthopaedics · 2017Article
- Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures.Acta orthopaedica et traumatologica turcica · 2017Article
- Non-operative treatment of four-part fractures of the proximal end of the humerus: results of a prospective and retrospective multicentric study.International orthopaedics · 2016Article
- Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft.International orthopaedics · 2016Article
- Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study.International orthopaedics · 2016Article
- Age-dependent variation of glenohumeral anatomy: a radiological study.International orthopaedics · 2016Article
- The outcome of hemiarthroplasty for proximal humeral fractures is dependent on the status of the rotator cuff.International orthopaedics · 2015Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of this study was to analyse the factors that influence surgeon decision-making in the treatment of proximal humerus fractures that might be considered for arthroplasty or open reduction and internal fixation.
methodsA total of 217 surgeons evaluated radiographs and clinical vignettes of ten patients with fractures of the proximal humerus. In addition to radiographs, we provided patient age, sex, trauma mechanism, activity level (sedentary-vigorously active), and physical status (normal healthy-moribund). Observers were asked to: (1) choose open reduction and internal fixation or hemiarthroplasty (closed question, one option) and (2) to briefly describe the factors that led to their decision (open-ended question). We assessed interobserver reliability using the Fleiss generalized kappa and analysed factors that influenced decision-making according to treatment choice.
resultsInternal fixation was the preferred treatment for the majority of fractures. The overall multirater agreement was fair (κ = 0.30), with a 75 % proportion of agreement. When asked to describe the factors that influenced decision-making, surgeons favouring internal fixation described patient-based factors in 52 %, fracture morphology in 51 %, surgeon factors in 42 %, and bone quality in 11 %. In contrast, fracture morphology was the most common factor (67 %) described by surgeons recommending replacement. Patient age, sex, activity level, physical status and the presence of angular displacement were associated with a recommendation for internal fixation.
conclusionThere is substantial variation in recommendations for internal fixation vs. arthroplasty for fractures of the proximal humerus that arises in large part from patient and surgeon factors.
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