No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures
DOI:
https://doi.org/10.1080/17453674.2021.1941629Abstract
Background and purpose — Clear and acknowledged treatment algorithms for proximal humeral fractures (PHFs) are lacking. Nevertheless, a change in treatment trends, including a change towards more reversed shoulder arthroplasties (RSA), has been observed during recent years. We examined the effect of these changes on reoperation rates.
Patients and methods — Between 2011 and 2017, 4,070 PHFs treated at Sahlgrenska University Hospital were registered prospectively in the Swedish Fracture Register (SFR) and followed up until 2019 (mean follow-up of 4.5 years). Data on all reoperations were gathered from the SFR and from medical records.
Results — The majority of PHFs were treated non-surgically and the proportion increased slightly, but not sta- tistically significantly, during the study period (from 76% to 79%). Of the surgically treated fractures, the proportion fixed with a plate decreased from 47% to 25%, while the use of RSA increased 9-fold (from 2.0% to 19%). 221 patients underwent 302 reoperations. For those primarily treated surgically, the reoperation rate was 17%. Among treatment modalities, plate fixation was associated with the highest reoperation rate (21%). Rate of reoperations remained con- stant during the study period, both for the entire study cohort and for the surgically treated patients
Interpretation — During the study period, treatment changes that are in accordance with recently published treat- ment recommendations were observed. However, these treatment changes did not affect the reoperation rate. Treatment with a plate, intramedullary nail, or hemiarthroplasty was associated with the highest reoperation rates. The fact that almost every 4th surgical procedure was a reoperation indicates a need for further improvement of modern treatment concepts for PHFs.
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Copyright (c) 2022 Carl Bergdahl , David Wennergren, Eleonora Swensson- Backelin, Jan Ekelund, Michael Möller
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.