Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons

Maximilian Kerschbaum; Daniel Pangerl; Leopold Henssler; Michael Akers; Florian Zeman; Volker Alt; Lisa Klute

doi:10.1016/j.jse.2024.09.026

Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons

J Shoulder Elbow Surg. 2024 Nov 21:S1058-2746(24)00843-7. doi: 10.1016/j.jse.2024.09.026. Online ahead of print.

Authors

Maximilian Kerschbaum¹, Daniel Pangerl¹, Leopold Henssler¹, Michael Akers², Florian Zeman³, Volker Alt¹, Lisa Klute⁴

Affiliations

¹ Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
² Department for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
³ Department of Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
⁴ Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Electronic address: lisa.klute@ukr.de.

PMID: 39579861
DOI: 10.1016/j.jse.2024.09.026

Abstract

Background: The increasing incidence of proximal humeral fractures (PHF) poses complex challenges in determining the optimal therapeutic strategies due to the diverse fracture patterns and individual patient characteristics. Traumatologists and orthopedic surgeons face significant decisions, as potential consequences such as pain, functional limitations, and complications may significantly affect patients' quality of life. Given the varying viewpoints on appropriate treatment modalities, a thorough examination of current care practices is crucial.

Methods: An adaptive online survey was conducted to present realistic case scenarios, aimed at elucidating decision-making processes in the management of proximal humeral fractures. This survey encompassed relevant patient and fracture-related variables, employing a dynamic querying algorithm that featured up to 48 conceivable case scenarios.

Results: Analysis of 7012 case scenarios unveiled significant differences in treatment preferences across distinct patient age groups. Plate osteosynthesis emerged as the preferred modality for individuals under 50 years of age with complex fracture patterns. On the other hand, a balanced consideration between plate osteosynthesis and reverse shoulder arthroplasty was observed in the 50-70 age cohort. Notably, respondents favored reverse shoulder arthroplasty as the treatment modality of choice for individuals over 70 years of age. A treatment algorithm was developed to outline decision pathways concisely, considering these patient age groups and the option of reverse shoulder arthroplasty.

Discussion and conclusion: This study provides clinically relevant insights into therapeutic decision-making processes in the management of proximal humeral fractures. The illustration of treatment preferences through a visualized algorithm serves as a crucial tool for evidence-based clinical decision-making, offering potential in enhancing the individualized care spectrum for patients with PHF.

Keywords: Proximal humeral fractures; humeral head fractures; shoulder; shoulder injuries; shoulder surgery.