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Member Research and Reports

Member Research and Reports

South Carolina: Study Finds Surgery Linked to Increased Mortality Rates among Older Adults with Proximal Humerus Fracture

Research conducted by investigators at the South Carolina SmartState Center for Effectiveness Research in Orthopaedics, at the University of South Carolina Arnold School of Public Health, in partnership with Prisma Health-Upstate has found that higher rates of surgery to treat proximal humerus fractures (i.e., a break in the upper part of the arm bone, between the elbow and shoulder) were associated with increased mortality rates and other adverse health outcomes. These associations were more pronounced among older adults and individuals with comorbidities and increased frailty.

Proximal humerus fractures account for four to six percent of all fractures and 10 percent of fractures among older adults (ages 65+). They are the third most common fracture sustained by older adults (after fractures of the hip and distal radius) Although younger individuals can experience proximal humerus fractures, the occurrence for this population is much lower – resulting from significant trauma such as a motor vehicle collision.

Older adults, especially those with risk factors such as osteoporosis and diabetes, can incur a proximal humerus fracture much more easily (e.g., a fall from standing height). Women are twice as likely as men to have this type of fracture, which may result in pain, swelling, decreased mobility and additional complications (e.g., axillary nerve/artery injury).

This study resulted from the investigators’ observation that treatment plans and treatment rates for patients varied widely, ranging from arm slings and physical therapy to – increasingly – surgery. The large variation in the use of surgery to treat fractures suggests a lack of treatment consensus for the condition.

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