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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000






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I lived in New York City until six months ago. Now I'm in the west with my daughter and son-in-law. I'm concerned because I saw a report that older folks like me (I'm 77-years-old) aren't always treated the same if living on the east coast compared to being out west. I'm in good health but would like to stay that way should anything happen to me. What do you know about this?

There is some suspicion that common problems among older adults are treated differently depending on where you live. One way regional differences can be tracked for adults is through Medicare-Part B. Data from those records can be reviewed to get a picture of patient demographics (age, sex, race, education level, diagnosis, type of treatment). In a recent study from Dartmouth Medical Center (in the east), one example of regional differences was published. Trends in proximal humeral fractures among the elderly were reported. Using information compiled through Medicare Part-B, the number of these fractures that have been occurred can be determined year-by-year. Surgical treatment and any repeat surgeries (e.g., remove hardware, perform a revision procedure) are recorded through billing codes used by surgeons. Proximal humeral fractures refers to a break in the upper arm bone close to the top (but below the round head that fits into the shoulder socket). The reason this particular fracture was chosen is because treatment changed when locking plate technology was developed. These specially designed plates can be used with patients who have osteoporosis (brittle bones) that might not heal well without some extra support. In order to compare treatment and results, data was collected for two one-year time periods (1999-2000 before locking plates were available and 2004-2005 after locking plates were developed). There are thousands of patients covered by Medicare -- too many to include in a single study. The authors selected a 20 per cent sample (all patients with a proximal humeral fracture treated surgically) from each time period. They did find regional differences but not always in treatment. For example, more fractures occurred in people living in the eastern United States compared to the western states. The reason(s) for this are unknown. The overall number of proximal humeral fractures has not changed from 1999 to 2005. The group most likely to have this type of fragility fracture was 75 to 84 years old, female, and Caucasian. Most of the time, proximal humeral fractures in this age group were treated conservatively (without surgery). Over time, there has been a 25 per cent increase in the number of patients treated surgically. This study is landmark because it raises an important public health issue. With more and more older adults entering their "senior" years, the number of fractures is anticipated to rise. The economic burden for fragility fractures will place a tremendous financial strain on the health care system. Surgeons want to reduce the number of failed procedures or need for additional surgery. Research to support treatment that yields the best outcomes for proximal humeral fractures is needed. When clinical practice guidelines can be determined and published, there should be no regional differences in how this problem is addressed.

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