How do surgeons decide when to treat proximal humerus fractures with operative versus nonoperative management?

Logan A. Reed, Kevin A. Hao, David A. Patch, Joseph J. King, Catherine Fedorka, Jaimo Ahn, Jason A. Strelzow, Jonah Hebert-Davies, Milton T.M. Little, Peter C. Krause, Joseph P. Johnson, Clay A. Spitler

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: The objective of this study was to determine the underlying factors that drive the decision for surgeons to pursue operative versus nonoperative management for proximal humerus fractures (PHF) and if fellowship training had an impact on these decisions. Methods: An electronic survey was distributed to members of the Orthopaedic Trauma Association and the American Shoulder and Elbow Surgeons Society to assess differences in patient selection for operative versus nonoperative management of PHF. Descriptive statistics were reported for all respondents. Results: A total of 250 fellowship trained Orthopaedic Surgeons responded to the online survey. A greater proportion of trauma surgeons preferred nonoperative management for displaced PHF fractures in patients over the age of 70. Operative management was preferred for older patients with fracture dislocations (98%), limited humeral head bone subchondral bone (78%), and intraarticular head split (79%). Similar proportions of trauma surgeons and shoulder surgeons cited that acquiring a CT was crucial to distinguish between operative and nonoperative management. Conclusion: We found that surgeons base their decisions on when to operate primarily on patient’s comorbidities, age, and the amount of fracture displacement when treating younger patients. Further, we found a greater proportion of trauma surgeons elected to proceed with nonoperative management in patients older than the age of 70 years old as compared to shoulder surgeons.

Original languageEnglish
Pages (from-to)3683-3691
Number of pages9
JournalEuropean Journal of Orthopaedic Surgery and Traumatology
Volume33
Issue number8
DOIs
StatePublished - Dec 2023

Keywords

  • Elbow
  • Fracture
  • Management
  • Proximal humerus
  • Shoulder
  • Trauma

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