Treatment patterns and outcomes in proximal humerus fracture management: a claims-based retrospective analysis of real-world US patient data

BACKGROUND: We evaluated factors associated with open reduction internal fixation (ORIF) and arthroplasty after proximal humerus fractures (PHF) and 12-month reoperation. METHODS: A retrospective cohort was created using US healthcare claims from 2016-2025. Multinomial regression assessed factors associated with treatment. Multivariable Cox proportional hazards models evaluated 12-month reoperation risk. RESULTS: Among 250,695 PHF patients, 86% were managed nonoperatively, 11% received ORIF, and 4% received arthroplasty. Among surgically treated patients, arthroplasty utilization increased modestly (24% to 29%), while ORIF declined (76% to 71%). Younger patients and males were more likely to undergo ORIF. Reoperation rates were 7.9% for ORIF and 7.8% for arthroplasty. In patients < 54 years, ORIF had lower reoperation rates than arthroplasty (males: 6.84% vs. 13.36%, p = 0.002; females: 6.62% vs.18.24%, p < 0.001); in females aged 65-75, arthroplasty had lower reoperation rates than ORIF (5.39% vs. 7.87%, p < 0.001). Soft tissue (23.3%), mechanical (17.6%), and nonunion (14.1%) complications were observed among ORIF reoperations, versus soft tissue (9.8%) and infection (8.8%) in arthroplasty reoperations. CONCLUSION: ORIF remains the most common surgery for PHFs, while arthroplasty use increased. Reoperation rates were lower in younger ORIF patients but higher in older females. These findings may inform decision-making for operative treatment for PHFs.