Cost-Minimization Analysis and Treatment Trends of Surgical and Nonsurgical Treatment of Proximal Humerus Fractures

Wu, Eric; Zhang, Steven E.; Truntzer, Jeremy; Gardner, Michael J.; Kamal, Robin N.

doi:10.1016/j.jhsa.2020.03.022

Cited by 13 publications

(13 citation statements)

References 28 publications

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“…Surgical treatment of proximal humeral fractures has been associated with complication rates as high as 49% and reoperation rates of 14%. Growing evidence from randomised controlled trials and meta-analyses showing similar outcomes between surgical and non-surgical management of proximal humeral fractures has called into question surgical treatment of such fractures for patients older than 65 562122. In addition to prospective trials, pooled data of previous studies in a recent Cochrane review showed no clinically important difference in functional outcomes and quality of life between surgical and non-surgical treatment of proximal humerus fractures at one to two year follow-up 816…”

Section: Discussionmentioning

confidence: 99%

“…8 16 Nonetheless, surgical treatment of this injury has been increasingly used over the past two decades. 5 Ironically, it was for the relevant age group of patients over the age of 65 that inter-rater agreement across the two species was equally poor.…”

Section: Principal Findingsmentioning

confidence: 99%

“…9 24 This risk is even more concerning from a health economic view, as previous epidemiological and cost analyses have shown that fractures of the shoulder contribute substantially to the rising treatment costs for upper limb fractures. 5…”

Section: Principal Findingsmentioning

confidence: 99%

“…[2][3][4] Therefore, management of proximal humeral fractures will increase in healthcare systems. 5 Although it is well known that most proximal humeral fractures (nearly 75%) can be treated nonoperatively with acceptable functional results, surgery became popular with advancements in the field of osteosynthetic implants, such as locking nails, plates, and prosthetic shoulder joint replacements. 4 The rates of surgically treated patients are higher than 25% in some institutions, leading to substantial variation worldwide in the management of this common injury.…”

Section: Introductionmentioning

confidence: 99%

“…In Finland, the incidence of proximal humeral fractures tripled between 1970 and 2002 to 105 per 100 000 people aged 60 or above 234. Therefore, management of proximal humeral fractures will increase in healthcare systems 5…”

Section: Introductionmentioning

confidence: 99%

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Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

Razaeian

Wiese

Zhang

et al. 2020

BMJ

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Objective To investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures. Design Uncontrolled, blinded, comparative behavioural analysis. Setting Germany and United States. Participants 10 blinded experts in the field of orthopaedic trauma surgery ( Homo chirurgicus accidentus ), with special focus on upper extremity surgery from Germany and the US, and five Barbary macaques ( Macaca sylvanus ) from a semi-free range enclosure. Main outcome measures The reliability of agreement between raters assessed with Fleiss’ ĸ. Results Barbary macaques seem to have inferior inter-rater reliability in comparison with experts for choice of treatment (non-surgical v surgical), but for the geriatric age group most frequently affected by proximal humeral fractures, they performed similarly to the experts in their choices of treatment and choice of surgical procedure. Agreement about predicted outcome was poor among the macaques and slight among the experts. All experts almost always predicted the outcome incorrectly and tended to underestimate it. While only 4 (4.4%) of 90 experts’ predictions were correct, 13 (28.9%) of 45 macaques’ predictions were correct. Conclusions Consensus on treatment and expected outcomes of proximal humeral fractures is lacking even beyond the human species. Although Barbary macaques tend to predict the clinical outcome more accurately, their reliability to assist surgeons in making a consistent decision is limited. Future high quality research is needed to guide surgeons’ decision making on the optimal treatment of this common injury.

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Section: Discussionmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

Razaeian

Wiese

Zhang

et al. 2020

BMJ

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Interventions for treating proximal humeral fractures in adults

Handoll

Elliott

Thillemann

et al. 2022

Cochrane Database of Systematic Reviews

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Analysis 1.11. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 or 4 weeks, Outcome 11 Changes in pain intensity (mm) from baseline: 100 mm visual analogue scale (positive change = less pain). . Analysis 1.12. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 or 4 weeks, Outcome 12 Range of motion at 6 months (degrees): difference between two shoulders. . . . . . . . . . . . . Analysis 1.13. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 or 4 weeks, Outcome

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Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

Voß

Pfeifer

Kerschbaum

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy. Methods Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention. Results A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis. Conclusion The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6–12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases. Level of evidence IV.

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Cost-Minimization Analysis and Treatment Trends of Surgical and Nonsurgical Treatment of Proximal Humerus Fractures

Cited by 13 publications

References 28 publications

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

Interventions for treating proximal humeral fractures in adults

Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

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