Variability in Operative Management of Proximal Humerus Fractures

Abstract

Background Controversy exists regarding the best methods for the operative management of proximal humerus fractures. We hypothesized that trauma surgeons perform the majority of these procedures and that there is variability in the type of fixation used at our institutions based on the type of fellowship training. Methods A retrospective review of 177 consecutive operative closed proximal humerus fractures was conducted. All images were classified based on the Neer system, including: simple (two-part surgical neck or isolated tuberosity) or complex (three- or four-part). Choice of fixation was determined based on surgeon subspecialty. Results One-hundred and nine procedures were performed by trauma, 45 by shoulder, and 17 by hand. Thirty-eight percent (67/177) were simple and 62% (110/177) were complex. A significant difference was only found in blade plating of two-part surgical neck fractures ( p < 0.05) and the management of tuberosity fractures ( p < 0.05). Analysis of complex fractures showed a significant difference in the rate of arthroplasty ( p < 0.05). Discussion Trauma surgeons perform the majority of procedures on proximal humerus fractures, although at a similar rate to shoulder surgeons. A significant difference in management was found with regard to the utilization of blade plating, arthroplasty and the management of tuberosity fractures.