February 18, 2020 | Erin Bluvas, bluvase@sc.edu
Research conducted by investigators at the South Carolina SmartState Center for Effectiveness Research in Orthopaedics in partnership with Prisma Health-Upstate has found that higher rates of surgery to treat proximal humerus fractures (i.e., a break in the upper part of the arm bone, between the elbow and shoulder) were associated with increased mortality rates and other adverse health outcomes. These associations were more pronounced among older adults and individuals with comorbidities and increased frailty.
Proximal humerus fractures account for four to six percent of all fractures and 10 percent of fractures among older adults (ages 65+). They are the third most common fracture sustained by older adults (after fractures of the hip and distal radius) Although younger individuals can experience proximal humerus fractures, the occurrence for this population is much lower – resulting from significant trauma such as a motor vehicle collision.
Older adults, especially those with risk factors such as osteoporosis and diabetes, can incur a proximal humerus fracture much more easily (e.g., a fall from standing height). Women are twice as likely as men to have this type of fracture, which may result in pain, swelling, decreased mobility and additional complications (e.g., axillary nerve/artery injury).
This study resulted from the investigators’ observation that treatment plans and treatment rates for patients varied widely, ranging from arm slings and physical therapy to – increasingly – surgery. The large variation in the use of surgery to treat fractures suggests a lack of treatment consensus for the condition.
“The continued use of surgery over time suggests that surgeons have observed many patients improve after surgical treatment,” says lead author Sarah Floyd, a research assistant professor in Arnold School’s Department of Health Services Policy and Management. “We wanted to understand the implications for higher surgical rates on patient outcomes.”
The team analyzed data from more than 72 thousand patients from a cohort study of Medicare beneficiaries with proximal humerus fractures in 2011.The proportion of patients who received one of four types of surgical treatments varied from 1.8 to 33.3 percent across geographical regions of the U.S. The areas of the country with higher rates of surgery were more likely to have higher rates of mortality as well.
“Orthopedic surgeons should be cautioned of the harms of extending the use of surgery to more clinically vulnerable patient subgroups,” Floyd says. “A reduction in surgery rates could reduce mortality and adverse event rates for patients with proximal humerus fracture.”
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