Treatment patterns of ABOS part II candidates: A decline of operative management among geriatric proximal humerus fractures over the decade (2010-2020)

Background: The purpose of this study was to assess trends in ABOS part II candidate's operative man-agement of geriatric ( >= 65 years) proximal humerus fractures over the 2010-2020 decade. Methods: This retrospective database cohort study utilized the American Board of Orthopaedic Surgery (ABOS) database for candidates taking Part II of their boards. Surgical coding was reviewed and the ICD10 data was correlated to the CPT code for shoulder arthroplasty or open reduction internal fixation. We in-vestigated the number of proximal humerus fracture operative cases per year, the percent arthroplasty used per year, the stratification of percent arthroplasty per orthopaedic fellowship subspecialty and geo-graphic region.Results: A total of 2,409 operative cases for proximal humerus fractures in patients 65 years of age and older were submitted by 1,420 ABOS candidates. There was a 37% reduction in operatively managed prox-imal humerus fractures among ABOS part II candidates between the first half of the decade (2010-2015, 263.2 + /-13.4) and the second half of the decade (2016-2020, 166 + /-31.2; p < .05). There also was a downward trend with a 53% reduction in percent treated with arthroplasty as compared to ORIF during those same windows (2010-2015, 34.4 + /-11.7) and (2016-2020, 16.2 + /-6.4; p < .5). Partitioned by single fellowship training, Shoulder and Elbow (S&E) surgeons performed the highest percent arthroplasty at 25.2%, followed by Sports at 23.1% and the lowest percent arthroplasty was Trauma at 11.7%. The South-east United States had the lowest percentage arthroplasty at 15.8% as compared to the Midwest (23.8%) and Northeast (25.8%).Conclusion: Despite the rapid growth of both the elderly population and related geriatric proximal humerus fractures, ABOS candidates are treating less with surgery. There has been approximately a 37% decrease in the total number of operatively treated proximal humerus fractures between the first and sec-ond half 2010-2020 decade. When operative treatment is performed, there is a trend towards ORIF over an arthroplasty. Trauma fellowship trained surgeons are less likely to perform an arthroplasty as com-pared to other subspecialties. The Southeast region is least likely to perform an arthroplasty as compared to the Midwest or Northeast.(c) 2022 Elsevier Ltd. All rights reserved.

Automated summary

This study found a 37% decrease in operatively treated proximal humerus fractures among ABOS candidates between 2010 and 2020, with a trend towards open reduction internal fixation over arthroplasty. Subspecialty trained surgeons showed variations in the use of arthroplasty, and the Southeast region was less likely to perform arthroplasty compared to other regions.