Trends in management of proximal humerus fractures in the United States : 1998-2009

Proximal humerus fractures (PHFs) are common but they do not have a standard of treatment. Historically, surgeons have opted for closed reduction percutaneous pinning (CRPP) or open reduction internal fixation (ORIF) for simple fractures and hemiarthroplasty (HA) for more complex fractures. ORIF has become increasingly popular because of its expanded utility with locking plates. The use of CRPP has declined and been limited to simple fractures with recent literature showing unexpectedly higher complication rates. Reverse total shoulder arthroplasty (RTSA) was introduced in the U.S. in 2003 and has been used to treat complicated shoulder problems such as cuff tear arthropathy, revision, and 4-part PHFs. The aim of this study was to analyze the shifting emphasis between operative modalities for displaced PHFs. We hypothesized that the rate of total shoulder arthroplasty (TSA) would increase after the introduction of RTSA