Impact of PROFHER on trends in proximal humerus fracture treatment in the United States.

Background: PROximal Fracture of the Humerus Evaluation by Randomization (PROFHER) was a randomized control trial (RCT) published in 2015 comparing outcomes of operative versus nonoperative treatment of proximal humerus fractures (PHFs), finding no difference in Oxford Shoulder Scores between operative and nonoperative groups at 2 and 5 years. This study investigated changes in PHF treatment patterns by American orthopedic surgeons after the publication of PROFHER in 2015.

Methods: Using the PearlDiver database, patients aged 16 years or older with closed PHFs without associated dislocation or pathologic fracture etiology between 2011 and 2019 were identified. Patients who underwent operative treatment, including open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), and hemiarthroplasty, were identified via current procedural terminology (CPT) codes. Data were analyzed using simple linear regression and piecewise linear regression to assess changes in rates of surgical management of PHFs starting in 2015.

Results: Simple linear regression analysis showed increases in total operative treatment, with increased rates of ORIF and TSA; hemiarthroplasty rates decreased. Piecewise linear regression showed no significant change in the rate of treatment per year after 2015 for total operative treatment, ORIF, or TSA.

Conclusions: PROFHER did not significantly impact rates of operative treatments for PHFs in the United States.

Level of evidence: Level III; Retrospective Case-Control Design Using Large Database; Prognosis Study.