The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. It is evident that proximal humerus fractures cause considerable morbidity among elderly people and consume health care resources.

Background COVID-19 outbreak lead to nationwide lockdown in Finland on the March 16th, 2020. Previous data regarding to the patient load in the emergency departments during pandemics is scarce. Our aim is to describe the effect of national lockdown and social distancing on the number and reasons for emergency department (ED) visits and inpatient admissions in three large volume hospitals prior to and after the outbreak of the COVID-19 epidemic in Finland. Methods Data for this register-based retrospective cohort study were collected from three large ED’s in Finland, covering 1/6 of the Finnish population. All patients visiting ED’s six weeks before and six weeks after the lockdown were included. Pediatric and gynecological patients were excluded. Numbers and reasons for ED visits and inpatient admissions were collected. Corresponding time period in 2019 was used as reference. Results A total of 40,653 ED visits and 12,226 inpatient admissions were analyzed. The total number of ED visits decreased 16% after the lockdown, whereas the number of inpatient admissions decreased 15% (p < 0.001). This change in inpatient admissions was similar in all participating hospitals. Visits due to back or limb pain decreased 31% and infectious diseases 28%. The visit rate and inpatient admissions due to acute myocardial infarction and strokes remained stable throughout the study period. Interestingly, the rate of inpatient admissions due to psychiatric diagnoses remained unchanged, although the ED visit rate decreased by 19%. The number of ED visits (n = 282) and inpatient admissions (n = 55) due to COVID-19 remained low in the participating hospitals. Conclusions Changes in ED visits and inpatient admissions prior to and during the early phase of the COVID-19 outbreak were unpredictable, and our results may help hospitals and especially ED’s focus their resources better. Surprisingly, there was a major decrease in the rate of ED visits due to back or limb pain and not so surprisingly in infectious diseases. Rates of acute myocardial infarctions and cerebral strokes remained stable. In summary, stabile resources for the treatment of patients with severe diseases will be needed in hospitals and ED’s.

Although the incidence of clavicle fractures increased in Sweden between 2001 and 2012, the rate of surgical treatment of clavicle fractures increased much more than could be expected solely based on the increase in the fracture incidence. The observed changes in the rates of surgery require additional studies since there is still controversy regarding the indications for surgical treatment.

Background Although increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures. Methods and findings The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded. Conclusions This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial. Trial registration ClinicalTrials.gov NCT01246167 .

BackgroundProximal humeral fractures are common osteoporotic fractures. Most proximal humeral fractures are treated non-surgically, although surgical treatment has gained popularity. The purpose of this study was to determine changes in the surgical treatment of proximal humeral fractures in Finland between 1987 and 2009.MethodsThe study covered the entire adult (>19 y) population in Finland over the 23-year period from 1st of January 1987 to 31st of December 2009. We assessed the number and incidence of surgically treated proximal humeral fractures in each year of observation and recorded the type of surgery used. The cohort study was based on data from Finnish National Hospital Discharge Register.ResultsDuring the 23-year study period, a total of 10,560 surgical operations for proximal humeral fractures were performed in Finland. The overall incidence of these operations nearly quadrupled between 1987 and 2009. After the year 2002, the number of patients treated with plating increased.ConclusionAn increase in the incidence of the surgical treatment of proximal humeral fractures was seen in Finland in 1987–2009. Fracture plating became increasingly popular since 2002. As optimal indications for each surgical treatment modality in the treatment of proximal humeral fractures are not known, critical evaluation of each individual treatment method is needed.