ArticleDeutsches Arzteblatt international2024
Conservative Versus Operative Treatment of Proximal Humerus Fractures in Older Individuals.
Article in Deutsches Arzteblatt international, 2024. 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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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.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Reverse total shoulder arthroplasty versus locked plate fixation for proximal humeral fractures in the elderly: a systematic review.PloS one · 2025Pooled it
- The replicability of real-world evidence for the surgical treatment of proximal humeral fractures in older patients evaluated using sceptical p-value.Scientific reports · 2026Observational
- How does the level of care change after proximal humeral fracture in older patients? A propensity score matching analysis.European geriatric medicine · 2026Article
- [Biomechanical aspects in the treatment of periprosthetic humeral fractures].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- 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
- The impact of prior level of care on the course of proximal humeral fractures in older patients: an analysis based on health insurance claims data.BMC health services research · 2026Article
- EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: REVERSE ARTHROPLASTY FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS.Acta ortopedica brasileira · 2026Review
- Geriatric-Typical Characteristic Complexes Predict Short-Term Outcome of Proximal Humeral Fractures in Geriatric Patients.Clinical interventions in aging · 2026Article
- Distal radius T-shaped locking plate with suture anchors for humeral greater tuberosity fracture with rotator cuff injury: A case report.SAGE open medical case reports · 2026Article
- Centenarians with proximal humeral fracture.BMC geriatrics · 2025Article
- Osteoporotic Fractures of the Proximal Humerus: an In-Depth Review of Current Management Options.Current osteoporosis reports · 2025Review
- Nonoperative treatment of proximal humerus fractures in the elderly.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Review
- Higher incidence of osteosynthesis of proximal humerus fractures in Germany-an epidemiological study comparing osteosynthesis of the proximal humerus and shoulder arthroplasty in Germany, Austria, and Switzerland.JSES international · 2025Article
- [Old and young-Differences in the treatment of proximal humeral fractures?]Unfallchirurgie (Heidelberg, Germany) · 2025Review
- Which Factors Influence the Need for Inpatient Aftercare of Elderly Patients After Hospital Treatment for Proximal Humerus Fractures?Geriatric orthopaedic surgery & rehabilitation · 2025Article
- Treatment of Proximal Humeral Fractures in Older Patients During COVID-19 Pandemic in Germany.Clinical epidemiology · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLittle is known about the frequency and results of conservative treatment of proximal humerus fractures (PHF) in older individuals.
methodsBilling data of the BARMER health insurance carrier for all patients of age ≥ 65 for the years 2005-2021 were retrospectively analyzed with multivariable Cox regression models, taking account of the patients' age, sex, and individual comorbidity profiles. The defined primary endpoints were overall survival (OS), major adverse events (MAE), thromboembolic events (TE), and complications of surgery or of trauma. Multivariable p-values for the effect of treatment on all primary endpoints were jointly adjusted using the Bonferroni-Holm method.
resultsOf 81 909 patients, 54% were treated conservatively. Conservative treatment was more common in those who received their diagnosis as outpatients (79.5%, vs. 37.2% for inpatients). Operative treatment was associated with significantly longer overall survival (long-term hazard ratio [HR] 0.89, 95% confidence interval [0.86; 0.91]), fewer MAE (0.90 [0.88; 0.92]), and fewer TE (0.89 [0.87; 0.92]), but more complications due to surgery or trauma (1.66 [1,.4; 1.78]; all p < 0.001). By 6 months after diagnosis, 3.1% of the patients who were initially treated conservatively had undergone surgery. Risk factors for failure of conservative treatment were alcohol abuse, obesity, cancer, diabetes mellitus, Parkinson disease, and osteoporosis.
conclusionThe conservative treatment of PHF is associated with a lower overall rate of complications due to surgery or trauma, but also with more MAE, more TE, and higher mortality. These findings underline the need for individualized and risk-adjusted treatment recommendations.
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