Proximal humerus fractures in patients over 65: Management profile based on national French PMSI data

INTRODUCTION: Proximal humerus fractures (PHFs) are the third most common fracture in adults, with a prevalence expected to increase in the coming years due to population aging and the growing functional demands of affected patients. HYPOTHESIS: The prevalence of different PHF treatments derived from the French national database is comparable to that reported in published international studies. MATERIALS AND METHODS: We conducted a retrospective review of the French national PMSI (Programme Médicalisé des Systèmes d'Information) database to identify, using diagnostic and therapeutic procedure codes, all patients aged 65 years or older who were hospitalized for PHF with an emergency department visit between 2014 and 2023. The different treatment approaches and their mid-term survival were analyzed. RESULTS: In our cohort, 75,495 patients (60.9%) were treated non-operatively, 29,852 patients (24.1%) underwent osteosynthesis only, and 17,719 patients (14.3%) received primary shoulder arthroplasty only. Patient survival at 48 months was 84%. Our analysis showed an increasing prevalence of non-operative management with advancing patient age and a growing proportion of shoulder arthroplasty in PHF treatment since 2014. CONCLUSION: In patients aged ≥ 65 years, surgery was the first-line treatment in 40% of cases. Functional demands led to secondary surgery in only 3% of fractures, regardless of the initial treatment approach. Non-operative management, with lower morbidity, appears to be a suitable option for this fragile yet functionally demanding population. LEVEL OF EVIDENCE: IV; database analysis, descriptive epidemiological study.