The incidence of proximal humerus fractures is rising, with increasing use of reverse total shoulder arthroplasty (rTSA). This study analyzed treatment trends, readmission rates, and causes of readmission. The Nationwide Readmissions Database (NRD) was queried for admissions with a primary diagnosis of proximal humerus fracture in the U.S. (2016-2021) using ICD-10 codes. Patient demographics, comorbidities, facility characteristics, and 30-/90-day readmission rates were analyzed. Treatments included non-operative (Non-Op), hemiarthroplasty (HA), anatomic total shoulder arthroplasty (aTSA), rTSA, open reduction internal fixation (ORIF), and intramedullary nailing (IMN). Among 218,425 admissions, rTSA use increased (20.27 % to 22.30 %), while ORIF decreased (20.77 % to 14.86 %). Non-Op had the highest readmission rates at 30- and 31-90 days (10.5 % and 8.9 %), even after adjusting for age/comorbidities. rTSA had the lowest readmission rates (5.9 % and 4.6 %), with instability being the most common cause. There is a trend towards increased rTSA utilization for treating proximal humerus fractures. The readmission rate following rTSA was the lowest of all treatment modalities, including non-operative management. Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.

Introduction: International medical graduates (IMGs) continue to play an important role in the US health care system, but little is known about their trends of matching into highly competitive residencies such as orthopedic surgery. The purpose of this study was to analyze temporal trends of IMG applicants matching into US orthopedic residency programs between 2008 and 2024 and compare them with US allopathic (MD) and osteopathic (DO) graduates. Methods: Orthopedic residency specific data for years 2008 to 2024 was obtained from the National Resident Match Program and Electronic Residency Application Service. Variables collected included total number of programs, total positions offered, number of applicants (MD, DO, and IMG), positions filled, and fill rate for each group. Trends were examined using simple linear regression modeling. Results: The number of orthopedic residency programs increased from 160 (2008) to 218 (2024), with total positions increasing from 636 (2008) to 916 (2024). The IMG fill rate decreased from 2.99% in 2008 to 0.87% in 2024 (p < 0.01 for linear trend; β −0.069). This corresponds to an absolute number decrease of 19 IMGs in 2008 to 8 in 2024. More specifically, the proportion of US IMGs decreased from 0.94% to 0.66%, and the proportion of non-US IMGs decreased from 2.04% to 0.21%. Over the 17-year study period, a total of 105 US IMGs and 110 non-US IMGs matched into orthopedic surgery. The US MD applicant fill rate decreased significantly from 96.5% to 85.0% (p < 0.001; β −0.944). The DO applicant fill rate increased significantly from 0.31% to 13.97% (p < 0.0001; β 0.990). Conclusion: The declining rate of IMGs matching into orthopedic residency programs in the United States underscores the growing challenges faced by IMGs in accessing training in this competitive specialty. The notable increase in DO graduates securing orthopedic residency positions likely reflects the integration of a unified accreditation system for MD and DO residency programs established in 2020. Level of Evidence: Retrospective Cohort Study; IV

Historically, humeral shaft fractures have been managed non-operatively in a functional brace. However, recent studies suggest an increase in rates of operative fixation. Disparities in surgical management based on insurance status have been demonstrated across many orthopedic conditions. This study aimed to identify if a correlation exists between insurance coverage and the probability of undergoing operative fixation for a humeral shaft fracture. A retrospective examination of the National Readmissions Database (NRD) from 2016 to 2021 was conducted. Patients diagnosed with isolated closed humeral shaft fractures were identified via International Classification of Disease, Tenth Revision (ICD-10) codes, and surgical interventions were identified using ICD-10 procedural codes. Utilizing weighted data, a total of 56,468 patients with isolated closed humeral shaft fractures were identified, 25,075 (44.4%) of whom underwent operative fixation. A univariate analysis was conducted using Pearson's chi-square test to isolate variables for inclusion in a multi-variable analysis. A binary logistic regression analysis was then employed to explore demographic and other pertinent factors. Findings were reported as odds ratios (ORs). After controlling for social and demographic variables, patients with Medicaid (OR, 0.54; 95% CI, 0.50-0.58; p<0.001), Medicare (OR, 0.64; 95% CI, 0.60 - 0.68; p<0.001), and self-pay patients (OR, 0.75; 95% CI, 0.67 - 0.84; p<0.001) were less likely to undergo operative fixation of humeral shaft fracture than those with private insurance. Patients without private insurance or those with no insurance coverage are less likely to undergo operative fixation for humeral shaft fractures compared to those with private insurance, even after adjusting for social and demographic variables. The observed variability underscores the necessity for more refined treatment guidelines for humeral shaft fractures. Surgeons should be aware of these potential biases affecting management decisions.