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The factors influencing the decision making of operative treatment for proximal humeral fractures

Hageman, Michiel G.J.S., Jayakumar, Prakash, King, John D., Guitton, Thierry G., Doornberg, Job N., Ring, David and Page, Richard 2015, The factors influencing the decision making of operative treatment for proximal humeral fractures, Journal of shoulder and elbow surgery, vol. 24, no. 1, pp. e21-e26, doi: 10.1016/j.jse.2014.05.013.

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Title The factors influencing the decision making of operative treatment for proximal humeral fractures
Author(s) Hageman, Michiel G.J.S.
Jayakumar, Prakash
King, John D.
Guitton, Thierry G.
Doornberg, Job N.
Ring, David
Page, RichardORCID iD for Page, Richard
Journal name Journal of shoulder and elbow surgery
Volume number 24
Issue number 1
Start page e21
End page e26
Total pages 6
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2015-01
ISSN 1058-2746
Summary Background:
The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations.
Methods: A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment.
Results: Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture me chanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon.
Conclusion: Patient information - older age in particular - is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations
Language eng
DOI 10.1016/j.jse.2014.05.013
Field of Research 110314 Orthopaedics
Socio Economic Objective 920116 Skeletal System and Disorders (incl. Arthritis)
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2015, Elsevier
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Document type: Journal Article
Collection: School of Medicine
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Created: Thu, 22 Oct 2015, 11:44:28 EST

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