ArticleJournal of orthopaedic surgery and research2019
Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus.
Article in Journal of orthopaedic surgery and research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The fragility and reverse fragility indices of proximal humerus fracture randomized controlled trials: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Pooled it
- Article
- Proximal humerus fractures: Treatment controversies.OTA international : the open access journal of orthopaedic trauma · 2025Article
- Human-centered design of a health recommender system for orthopaedic shoulder treatment.BMC medical informatics and decision making · 2025Article
- Trends in Epidemiology and Treatment of Humerus Fractures in the United States, 2017-2022.Cureus · 2024Article
- Regional variations in incidence and treatment trends of Achilles tendon ruptures in Finland: a nationwide study.Acta orthopaedica · 2024Article
- Understanding Changing Demographic and Treatment Trends of Distal Radius Fractures: A TriNetX Database Contemporary Analysis of 32,912 Patients.Journal of hand surgery global online · 2024Article
- Biomechanical analysis of push-pull principle versus traditional approach in locking plates for proximal humeral fracture treatment.Archives of orthopaedic and trauma surgery · 2024Article
- Human-centered Design of a Health Recommender System for Orthopaedic Shoulder Treatment.Research square · 2024Article
- The surgical treatment of proximal humerus fractures 2010-2019: United States national case volume and incidence trends.JSES reviews, reports, and techniques · 2024Article
- Outcomes after salvage reverse shoulder arthroplasty for failed primary fixation or hemiarthroplasty for proximal humerus fractures: A systematic review.Shoulder & elbow · 2023Review
- Generating Practice-Based Evidence in the Use of Guideline-Recommended Combination Therapy for Secondary Prevention of Acute Myocardial Infarction.Pharmacy (Basel, Switzerland) · 2022Article
- Assessing the ability of an instrumental variable causal forest algorithm to personalize treatment evidence using observational data: the case of early surgery for shoulder fracture.BMC medical research methodology · 2022Article
- Factors related to initial treatment for adhesive capsulitis in the medicare population.BMC geriatrics · 2022Article
- What are the health consequences associated with differences in medical malpractice liability laws? An instrumental variable analysis of surgery effects on health outcomes for proximal humeral facture across states with different liability rules.BMC health services research · 2022Article
- Proximal humerus fractures: epidemiology and trends in surgical management of hospital-admitted patients in Portugal.JSES international · 2022Article
- Variation in neurosurgical intervention for severe traumatic brain injury: The challenge of measuring quality in trauma center verification.The journal of trauma and acute care surgery · 2021Article
- Association of Surgical Treatment With Adverse Events and Mortality Among Medicare Beneficiaries With Proximal Humerus Fracture.JAMA network open · 2020Article
- Position statement: management of proximal humerus fractures.Canadian journal of surgery. Journal canadien de chirurgieReview
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUsing a larger, more comprehensive sample, and inclusion of the reverse shoulder arthroplasty as a primary surgical approach for proximal humerus fracture, we report on geographic variation in the treatment of proximal humerus fracture in 2011 and comment on whether treatment consensus is being reached.
methodsThis was a retrospective cohort study of Medicare patients with an x-ray-confirmed diagnosis of proximal humerus fracture in 2011. Patients receiving reverse shoulder arthroplasty, hemiarthroplasty, or open reduction internal fixation within 60 days of their diagnosis were classified as surgical management patients. Unadjusted observed surgery rates and area treatment ratios adjusted for patient demographic and clinical characteristics were calculated at the hospital referral region level.
resultsAmong patients with proximal humerus fracture (N = 77,053), 15.4% received surgery and 84.6% received conservative management. Unadjusted surgery rates varied from 1.7 to 33.3% across hospital referral regions. Among patients receiving surgery, 22.3% received hemiarthroplasty, 65.8% received open reduction internal fixation, and 11.8% received reverse shoulder arthroplasty. Patients that were female, were younger, had fewer medical comorbidities, had a lower frailty index, were white, or were not dual-eligible for Medicaid during the month of their index fracture were more likely to receive surgery (p < .0001). Geographic variation in the treatment of proximal humerus fracture persisted after adjustment for patient demographic and clinical differences across local areas. Average surgery rates ranged from 9.9 to 21.2% across area treatment ratio quintiles.
conclusionsPersistent geographic variation in surgery rates for proximal humerus fracture across the USA suggests no treatment consensus has been reached.
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