Vol.:(0123456789) 1 3 Archives of Orthopaedic and Trauma Surgery https://doi.org/10.1007/s00402-019-03252-1 TRAUMA SURGERY Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016 Alexander Klug 1  · Yves Gramlich 1  · Dennis Wincheringer 1  · Kay Schmidt‑Horlohé 2  · Reinhard Hofmann 1 Received: 5 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Introduction Proximal humeral fractures (PHF) are among the most common adult fractures. However, valid epidemiologic population-based data, including diferentiation of treatment modalities, are lacking. Materials and methods Using the ICD codes and associated OPS codes for PHF, a retrospective analysis of 2007–2016 Federal Statistical Ofce of Germany data was performed. Data were evaluated for total incidence of PHF as well as total use, annual utilization rates, age, and sex distributions of all associated surgical procedures. Simple linear regressions were performed to evaluate trends in treatment modalities. Results There were 642,556 cases of PHF. During the study period, incidence changed substantially from 65.2 to 74.2 per 100,000 inhabitants with a signifcant rise in elderly (> 70 years) patients (P < 0.001). The number of surgical procedures increased by 39%, with locking plate fxation being the most common procedure (48.3%), followed by intramedullary nailing (IMN) (20.0%), hemiarthroplasty (HA) (7.5%), K-wire fxation (6.4%), and reverse shoulder arthroplasty (RSA) (5.6%). The utilization rate increased for locking plates, K-wires, and RSA and decreased for HA and IMN. Particularly, the utilization of RSA exhibited a > eightfold increase. Signifcant linear correlation of procedure and time were found for all surgical treatments. Conclusions During this period, the number of inpatient PHFs, especially in the elderly, increased. Although locking plate fxation remained the most common treatment method, RSA had the greatest proportional increase over time, supporting its growing popularity in the light of the current scientifc evidence. This incline was ofset by a corresponding decrease in HA and IMN, which may be related to a growing knowledge of their application limitations. Level of evidence Descriptive epidemiology study, large database analysis. Keywords Proximal humeral fractures · Treatment patterns · Hemiarthroplasty · Reverse shoulder arthroplasty · Locking plate · Epidemiology Alexander Klug and Yves Gramlich contributed equally to this publication. * Alexander Klug alexander.klug@bgu-frankfurt.de Yves Gramlich yves.gramlich@bgu-frankfurt.de Dennis Wincheringer dennis.wincheringer@bgu-frankurt.de Kay Schmidt-Horlohé schmidt-horlohe@orthopaedicum-wiesbaden.de Reinhard Hofmann reinhard.hofmann@bgu-frankfurt.de 1 Zentrum für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany 2 Orthopaedicum Wiesbaden, Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Friedrichstrasse 29, 65185 Wiesbaden, Germany