Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons.

Background: The increasing incidence of proximal humeral fractures (PHF) poses complex challenges in determining the optimal therapeutic strategies due to the diverse fracture patterns and individual patient characteristics. Traumatologists and orthopedic surgeons face significant decisions, as potential consequences such as pain, functional limitations, and complications may significantly affect patients' quality of life. Given the varying viewpoints on appropriate treatment modalities, a thorough examination of current care practices is crucial.

Methods: An adaptive online survey was conducted to present realistic case scenarios, aimed at elucidating decision-making processes in the management of proximal humeral fractures. This survey encompassed relevant patient and fracture-related variables, employing a dynamic querying algorithm that featured up to 48 conceivable case scenarios.

Results: Analysis of 7012 case scenarios unveiled significant differences in treatment preferences across distinct patient age groups. Plate osteosynthesis emerged as the preferred modality for individuals under 50 years of age with complex fracture patterns. On the other hand, a balanced consideration between plate osteosynthesis and reverse shoulder arthroplasty was observed in the 50-70 age cohort. Notably, respondents favored reverse shoulder arthroplasty as the treatment modality of choice for individuals over 70 years of age. A treatment algorithm was developed to outline decision pathways concisely, considering these patient age groups and the option of reverse shoulder arthroplasty.

Discussion and conclusion: This study provides clinically relevant insights into therapeutic decision-making processes in the management of proximal humeral fractures. The illustration of treatment preferences through a visualized algorithm serves as a crucial tool for evidence-based clinical decision-making, offering potential in enhancing the individualized care spectrum for patients with PHF.