Evidence map›Paper›PMID 41184974›Full record

ArticleBMC medicine2025

Variations in surgical practice and adverse events following isolated proximal humerus fracture in adults - a comparative longitudinal cohort study of 53,852 patients from Denmark, England, and Sweden.

Helle K Østergaard, Jennifer C E Lane, Merete Nørgaard Madsen, Li Felländer-Tsai, Hans E Berg, Marianne Toft, Abdul Rashid Qureshi, Richard Craig, Dominic Furniss, Matthew Costa and 4 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Helle K ØstergaardDepartment of Orthopaedics, Viborg Regional Hospital, Heibergs Allé 5A, 8800, Viborg, Denmark. helle.oestergaard@viborg.rm.dk.
Jennifer C E LaneBarts Bone and Joint Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
Merete Nørgaard MadsenUniversity Clinic for Interdisciplinary Orthopaedic Pathways (UCOP), Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1P, 8600, Silkeborg, Denmark.
Li Felländer-TsaiDivision of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Emergency & Reparative Medicine Theme, Karolinska Institutet, Karolinska University Hospital, 54141 86, Reconstructive OrthopaedicsHuddinge, K , Sweden.
Hans E BergDivision of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Emergency & Reparative Medicine Theme, Karolinska Institutet, Karolinska University Hospital, 54141 86, Reconstructive OrthopaedicsHuddinge, K , Sweden.
Marianne ToftDepartment of Orthopaedics, Viborg Regional Hospital, Heibergs Allé 5A, 8800, Viborg, Denmark.
Abdul Rashid QureshiDivision of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, M99 Karolinska Huddinge, 14186, Stockholm, Sweden.
Richard CraigMilton Keynes University Hospital, Milton Keynes, Standing Wy, Eaglestone, Milton Keynes , MK6 5LD, UK.
Dominic FurnissNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciencesand the , NIHR Oxford Biomedical Research Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7HE, UK.
Matthew CostaNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciencesand the , NIHR Oxford Biomedical Research Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7HE, UK.
Stephen GwilymNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciencesand the , NIHR Oxford Biomedical Research Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7HE, UK.
Inger MechlenburgDepartment of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.
Antti P LaunonenDepartment of Sensory, Musculoskeletal Diseases Centre, Neural, and Musculoskeletal Medicine, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Elämänaukio 2, 33520, Tampere, Finland.
Jonathan L ReesNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciencesand the , NIHR Oxford Biomedical Research Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7HE, UK.

Funding

Academy of Finland (APL) ref 341375National Institute for Health Research Barts Biomedical Research Centre (NIHR203330)regional agreement on medical training and clinical research (ALF, Region Stockholm) dnr. RS 2019-1054
6 · The paper itself

Abstract

backgroundProximal humeral fractures (PHFs) are common injuries, but their management has remained controversial. Recent high-level evidence from randomized clinical trials has shown that for many PHFs, surgical treatment is not superior to non-surgical treatment. Our primary aim was to conduct a multi-nation assessment of temporal trends and changes in surgical treatment of isolated PHF in Denmark, England, and Sweden. A secondary aim was to estimate the incidence of serious adverse events (SAEs) within 30 days (and death within 90 days) of primary surgery.

methodsThis population-based cohort study presents routinely collected data from Danish, English, and Swedish patient registries and electronic health records from 1998 to 2018. All adult patients with isolated PHFs combined with predefined surgical procedure codes were included. Age- and sex-specific incidence rates (IRs) of surgery and each surgical procedure per calendar year were calculated. Kaplan-Meier plots displayed patient survival for the study period. Incidence proportions of SAEs within 30 days (and death within 90 days) of surgery were computed.

resultsA total of 54,077 primary surgical procedures, performed in 53,852 patients with isolated PHF, were included. Denmark and Sweden had the highest IR of surgery, with Denmark peaking at 17.4/100,000 person-years in 2011 and Sweden peaking at 18/100,000 person-years in 2013, while England peaked at 5/100,000 person-years in 2010. From 2004, plate fixation was the leading surgical procedure in Denmark and Sweden, while arthroplasty was the most frequent in England. The IR of surgery in Denmark and Sweden was 8-10 times higher for women aged 80 years than that observed in England. The 30-day incidence of SAEs varied between countries, ranging from 0.03% to 3.51%.

conclusionsVariations in surgical practice for isolated PHF exist between Denmark, England, and Sweden, with differences in overall IRs of surgery and preferred procedures. A complex interplay between hospitals, surgeons, healthcare systems, and evidence-based factors is likely to explain such variations. However, in all three countries, the IR of surgery, particularly for the use of locking plates, demonstrated a decline from 2013, coinciding with high-quality trials and meta-analyses suggesting that evidence-based factors are becoming more prominent in orthopaedic treatment decisions.

Indexed as

Postoperative ComplicationsShoulder FracturesAdultAgedAged, 80 and overDenmarkEnglandFemaleHumansIncidenceLongitudinal StudiesMaleMiddle AgedRegistriesSwedenCohort studyIncidence ratesMulti-nationalShoulder fractureSurgical treatmentTemporal trends

Identifiers

PMID41184974
PMCPMC12581428

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.