J Am Acad Orthop Surg. 2025 Aug 28. doi: 10.5435/JAAOS-D-25-00378. Online ahead of print.
ABSTRACT
INTRODUCTION: Treatment approaches and functional outcomes have been shown to be influenced by a patient’s socioeconomic status in certain orthopaedic pathologies. In patients with proximal humerus fractures (PHFs), this study aimed to evaluate the relationship between social deprivation and (1) treatment strategy-including the choice between surgical and nonsurgical management, as well as the type of surgical intervention-and (2) patient-reported outcomes.
METHODS: We retrospectively reviewed 275 displaced PHFs from a level 1 trauma center. Using the Area Deprivation Index (ADI), patients were assigned social deprivation scores ranging from 0 to 100, with higher scores representing greater deprivation. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to measure the domains of Physical Function, Upper Extremity, Pain Interference, Depression, and Anxiety. PROMIS scores were grouped into 6-week, 3-month, 6-month, and 1-year follow-up groups, with scores analyzed separately at each time point. The associations between ADI and treatment strategy and PROMIS outcomes were determined using multivariable logistic regression and multivariable linear regression, respectively.
RESULTS: ADI showed no significant association with surgical versus nonsurgical treatment (odds ratio = 0.998 [95% confidence interval, 0.987 to 1.010], P = 0.790) or type of surgical treatment (odds ratio = 1.009 [confidence interval, 0.994 to 1.024], reverse total shoulder arthroplasty vs locking compression plate, P = 0.251). In the 6-week, 3-month, 6-month, and 1-year follow-up analyses, ADI showed no significant associations with PROMIS Physical Function, Upper Extremity, Pain Interference, Depression, or Anxiety.
CONCLUSION: This study showed that social deprivation was not markedly associated with treatment strategy or patient-reported outcomes in patients with PHFs. Additional prospective research is needed to clarify the impact of social deprivation on patients with PHFs and to determine the appropriate role of area-based deprivation indices in orthopaedic care.
PMID:40907000 | DOI:10.5435/JAAOS-D-25-00378
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