Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany
Background: The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation ca...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-02-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/4/1440 |
| _version_ | 1797620171679989760 |
|---|---|
| author | Robert Rischen Jeanette Köppe Josef Stolberg-Stolberg Moritz Freistühler Andreas Faldum Michael J. Raschke J. Christoph Katthagen |
| author_facet | Robert Rischen Jeanette Köppe Josef Stolberg-Stolberg Moritz Freistühler Andreas Faldum Michael J. Raschke J. Christoph Katthagen |
| author_sort | Robert Rischen |
| collection | DOAJ |
| description | Background: The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time. Methods: Retrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal–Wallis tests. Results: Of the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: −35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; <i>p</i> < 0.001), and a 30-day mortality of 2%. Conclusions: Within an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages. |
| first_indexed | 2024-03-11T08:37:18Z |
| format | Article |
| id | doaj.art-0943036eccbe498187be0da3a2d09c72 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T08:37:18Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0943036eccbe498187be0da3a2d09c722023-11-16T21:19:35ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01124144010.3390/jcm12041440Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in GermanyRobert Rischen0Jeanette Köppe1Josef Stolberg-Stolberg2Moritz Freistühler3Andreas Faldum4Michael J. Raschke5J. Christoph Katthagen6Clinic for Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, GermanyInstitute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, GermanyMedical Management Division—Medical Controlling, University Hospital Muenster, Niels-Stensen-Straße 8, 48149 Muenster, GermanyInstitute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, GermanyBackground: The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time. Methods: Retrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal–Wallis tests. Results: Of the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: −35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; <i>p</i> < 0.001), and a 30-day mortality of 2%. Conclusions: Within an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages.https://www.mdpi.com/2077-0383/12/4/1440health claims datageriatric surgeryproximal humeral fracturelocking plate fixationosteosynthesisaugmentation |
| spellingShingle | Robert Rischen Jeanette Köppe Josef Stolberg-Stolberg Moritz Freistühler Andreas Faldum Michael J. Raschke J. Christoph Katthagen Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany Journal of Clinical Medicine health claims data geriatric surgery proximal humeral fracture locking plate fixation osteosynthesis augmentation |
| title | Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany |
| title_full | Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany |
| title_fullStr | Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany |
| title_full_unstemmed | Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany |
| title_short | Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany |
| title_sort | treatment reality of proximal humeral fractures in the elderly trending variants of locking plate fixation in germany |
| topic | health claims data geriatric surgery proximal humeral fracture locking plate fixation osteosynthesis augmentation |
| url | https://www.mdpi.com/2077-0383/12/4/1440 |
| work_keys_str_mv | AT robertrischen treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany AT jeanettekoppe treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany AT josefstolbergstolberg treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany AT moritzfreistuhler treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany AT andreasfaldum treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany AT michaeljraschke treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany AT jchristophkatthagen treatmentrealityofproximalhumeralfracturesintheelderlytrendingvariantsoflockingplatefixationingermany |