![]() The incidence of reported OF and RHNF was examined and trend changes for each fracture type were reported. Radial head arthroplasty (RHA), ORIF, and non-operative treatment of RHNF were identified using ICD-9 and CPT codes (Table 1). RHNF were queried via the Humana database using ICD-9 codes 813.05 (closed fracture of head of radius), 813.15 (open fracture of neck of radius), 813.06 (closed fracture of neck of radius), 813.16 (open fracture of neck of radius), 813.07 (other and unspecified closed fracture of proximal end of radius, alone) and 813.17 (other and unspecified open fracture of proximal end of radius, alone). *These codes were used in the query of both ORIF for Olecranon fractures and ORIF of radial head and neck fractures. Non- operative Management of Radial Head and Neck FracturesĬlosed treatment of radial head or neck fracture without manipulationĬlosed treatment of radial head or neck fracture with manipulationĬPT, Current Procedural Terminology (American Medical Association, Chicago, IL, USA) ICD-9, International Classification of Diseases, Ninth Edition. Open treatment of radial head or neck fracture with or without internal fixation or radial head excision with radial head prosthetic replacement Non- operative Management of Olecranon FractureĬlosed treatment of olecranon process without manipulationĬlosed treatment of olecranon process with manipulation Open reduction of separated epiphysis, radius and ulna Open reduction of fracture with internal fixation, radius and ulna Internal fixation of bone without fracture reduction, radius and ulna ORIF of Olecranon Fracture OR Radial Head and Neck Fracture* Open treatment of radial head or neck fracture with or without internal fixation or radial head excision Open treatment of olecranon process with or without internal or external fixation Codes used for the query of Humana database. A sub-analysis stratification of OF by age was untaken patients between the ages of 15-74 years (Group A) and greater than 75 years (Group B) were reviewed. Open reduction with internal fixation and non-operative treatment of OF was identified via ICD-9 and CPT codes (Table 1). Pearl Diver software provides access to the Humana registries with the use of Current Procedural Terminology (CPT American Medical Association, Chicago, IL, USA) codes, as well as, International Classification of Disease Ninth Edition (ICD-9) codes.Ī query of the Humana database was performed for OF using ICD-9 codes 813.01 (closed fracture of olecranon process), 813.11 (open fracture of olecranon process), 813.04 (other and unspecified closed fracture of proximal end of ulna, alone), and 813.14 (other and unspecified open fractures of the proximal end of ulna, alone). Data compiled within the Humana database are derived from a combination of Medicare/Medicare Advantage and private-payers yielding 18,620,198 patients from 2007-2014. This software is a publicly available Health Insurance Portability and Accountability Act-compliant database that compiles the entire Humana files into a server. We hypothesize a gradual increase in patients being treated with RHA for RHNF and non-operative management for OF compared with ORIF for these fractures during this time period.Ī retrospective review of the entire Humana database for radial head and neck fractures as well as olecranon fractures in patients over 15 years old was conducted through the use of the Pearl Diver supercomputer (Warsaw, IN, USA). The purpose of this study is to examine the national trends for management of two common elbow fractures-1) radial head and neck fractures (RHNF) 2) olecranon fractures – using the Humana claims database between 20. While the literature has helped to outline those fractures that might best be treated with surgery, and innovations in surgical technique and surgical implants have continued to improve, national trends have not been examined to determine the impact of these advances. Furthermore, those fractures that contain three or more fragments are often managed with radial head arthroplasty (RHA), as osteosysnthesis has been shown to result in high rates of unsatisfactory outcomes. More recently, osteosynthesis has been suggested when the displaced fragments result in a loss of forearm rotation or are combined with ligamentous injuries. Displaced radial head fractures have historically been managed with osteosynthesis or radial head excision. However, there has been a more recent emphasis on non-operative treatment of displaced olecranon fractures (OF) in the elderly. ĭisplaced fractures of the olecranon have historically been managed with variable methods of osteosynthesis. While minimally-displaced, stable fractures are typically managed with non-operative treatment, those that are significantly displaced or comminuted are commonly treated with surgical intervention. Fractures of the proximal ulna and radius are the most commonly observed elbow fractures.
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