Humeral shaft fractures: national trends in management

Journal of Orthopaedics and Traumatology

Original Article

James Krieg¹  Mitchell Maltenfort¹  Surena Namdari¹  Bradley S. Schoch²  Eric M. Padegimas³ 

[1] Department of Orthopaedic Surgery, Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, 19107, Philadelphia, PA, USA;Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA;Department of Orthopedics, Thomas Jefferson University, Philadelphia, PA, USA;

关键词: Nationwide inpatient sample;    NIS;    Humerus fracture;    Non-operative;    Open reduction internal fixation;   

DOI  :  10.1007/s10195-017-0459-6

 received in 2016-11-02, accepted in 2017-04-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe incidence of humeral shaft fractures has been increasing over time. This represents a growing public health concern in a climate of cost containment. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention.Materials and methodsHumeral shaft fractures were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 812.21 and 812.31 in the United States Nationwide Inpatient Sample from 2002 to 2011. Open reduction and internal fixation (ORIF) was identified by code 79.31 (ORIF, humerus). Other case codes analyzed were 79.01 (closed reduction without internal fixation), 79.11 (closed reduction with internal fixation), and 79.21 (open reduction without internal fixation). Multivariate regression analysis was utilized to determine predictive factors for utilization of ORIF.Results27,908 humeral shaft fractures were identified. Utilization of ORIF increased from 47.2% of humeral shaft fractures in 2002 to 60.3% in 2011. Demographically, patients who underwent ORIF were younger (51.5 versus 59.7 years, p < 0.001; odds ratio 0.87 per decade of age). There were modest increases in ORIF usage with private insurance, open fracture, and hospital size, which persisted with multivariate regression analysis. Surprisingly, there was a tendency to shift from a slight increase in ORIF for males with the bivariate case to a slight preference for females in the multivariate case.ConclusionUtilization of ORIF for humeral shaft fractures has been steadily increasing with time. Surgical intervention was more common with younger patients, female gender, private insurance, and larger hospital size. The increasing incidence of surgical management for humeral shaft fractures may represent a public health burden given the historical success of non-operative management.Level of evidenceIV.

【 授权许可】

CC BY   
© The Author(s) 2017