Trends in the surgical management of proximal humerus fractures over the last 20 years from Australian registry databases

Background: Proximal humerus fractures (PHF) are common with approximately 30% requiring surgical intervention. This ranges from open reduction internal fixation (ORIF) to shoulder arthroplasty (including hemiarthroplasty, total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA)). The aim of this study was to assess trends in operative interventions for PHF in an Australian population. Methods: Data was retrospectively collected for private patients with a PHF and requiring surgical intervention (2001–2020). Data for patients undergoing ORIF were extracted from the Medicare database, while those receiving arthroplasty for PHF were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Results: Across the study period, ORIF was the most common surgical procedure for management of PHFs. While the number of RTSA procedures for PHF has increased, shoulder hemiarthroplasty has significantly reduced since 2008 (p < 0.001). Patients aged < 65 years were more likely to receive ORIF. Patients aged ≥ 65 years were more likely to receive RTSA or hemiarthroplasty compared to patients aged < 65 years. Conclusions: While the number of ORIF procedures has increased during the period of interest, it has diminished slightly as a proportion of overall procedure volume. RTSA is becoming increasingly popular, with decreasing utilization of hemiarthroplasty, and TSA for fracture remaining uncommon. Level of evidence: Level III.