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.