Humeral shaft fractures account for approximately 3% of all fractures. Nonsurgical management of humeral shaft fractures with functional bracing gained popularity in the 1970s, and this method is arguably the standard of care for these fractures. Still, surgical management is indicated in certain situations, including polytraumatic injuries, open fractures, vascular injury, ipsilateral articular fractures, floating elbow injuries, and fractures that fail nonsurgical management. Surgical options include external fixation, open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and antegrade or retrograde intramedullary nailing. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. However, good surgical outcomes can be achieved with proper patient selection.

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Purpose of review The goal of this manuscript is to provide an overview and analysis of bundled payment models for joint replacement and select spine procedures. Advantages and disadvantages of bundled payment models will be discussed. Recent findings In select populations, bundled payment models have been shown to reduce costs while maintaining satisfactory outcomes. These models have not been tested with complex patient cohorts, such as older adults with fragility hip fractures, and limited data exist with bundled payment analysis in spine procedures. Summary The reduction of healthcare costs, satisfactory patient outcomes, and favorable payments to healthcare systems can be achieved through bundled payments. Modifications of existing bundled payment models should be critically tested prior to implementation across higher risk populations. Bundled payment models will also require healthcare systems to define what services are necessary for an episode of care regarding a specific condition or disease.

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.