Author Contributions
Conceptualization, R.H., P.H., and J.C.K.; Data curation, M.W.; Formal analysis, M.W.; Investigation, R.H., B.M., S.K., M.G., M.K., I.T., R.-O.D.H., B.B., and J.C.K.; Methodology, R.H., M.W., and J.C.K.; Project administration, P.H., M.D., P.-J.B., J.Z., T.A.S., T.S., H.L., R.G., and M.J.R.; Software, M.W.; Supervision, P.H., M.D., J.Z., T.A.S., T.S., H.L., R.G., and M.J.R.; Validation, R.H. and J.C.K.; Writing—original draft, R.H., M.W., and J.C.K.; Writing—review and editing, P.H., B.M., P.-J.B., J.Z., M.G., M.K., T.S., I.T., R.-O.D.H., R.G., and B.B. All authors have read and agreed to the published version of the manuscript.
Table 1.
Patient characteristics: part 1. m—meter, kg—kilogram, BMI—body mass index.
Table 1.
Patient characteristics: part 1. m—meter, kg—kilogram, BMI—body mass index.
| Mean | Std. Dev. | Minimum | Maximum | Missing Values |
---|
Age (years) | 66.9 | 17.3 | 8 | 101 | 2 |
Height (m) | 1.68 | 0.10 | 1.28 | 2.05 | 1319 |
Weight (kg) | 75.2 | 18.6 | 23.0 | 240.0 | 1291 |
BMI (kg/m2) | 26.7 | 5.8 | 9.0 | 69.4 | 1322 |
Table 2.
Patient characteristics: part 2. ASA—American Society of Anesthesiologists.
Table 2.
Patient characteristics: part 2. ASA—American Society of Anesthesiologists.
| Number | Percent |
---|
Sex: male/female | 1267/2747 | 31.5/68.4 |
Sex: missing values | 5 | 0.1 |
Age: 08–39/40–64 years | 311/1326 | 7.7/33.0 |
Age: 65–79/80–101 years | 1342/1038 | 33.4/25.8 |
Age: missing values | 2 | 0.0 |
ASA class 1/2 | 499/1372 | 12.4/34.1 |
ASA class 3/4/5 | 1155/174/9 | 28.7/4.3/0.2 |
ASA class: missing values | 810 | 20.2 |
Comorbidities: none/1 to 3 | 911/1966 | 22.7/48.9 |
Comorbidities: 4 or 5/6 and more | 579/455 | 14.4/11.3 |
Comorbidities: missing values | 108 | 2.7 |
Diabetes mellitus: yes/no | 676/2878 | 16.8/71.6 |
Diabetes mellitus: unknown | 465 | 11.6 |
Immunosuppressive medication: yes/no | 102/3541 | 2.5/88.1 |
Immunosuppressive medication: unknown | 376 | 9.4 |
Smoker: yes/no | 483/2575 | 12.0/64.1 |
Smoker: unknown | 961 | 23.9 |
Substance abuse: yes/no | 320/2777 | 8.0/69.1 |
Substance abuse: unknown | 922 | 22.9 |
Living situation: self-sustaining/supervision/nursing home | 2817/276/267 | 70.1/6.9/6.6 |
Living situation: unknown | 659 | 16.4 |
Table 3.
Description and classification of fractures.
Table 3.
Description and classification of fractures.
| Number | Percent |
---|
Injured side: right/left | 1966/2035 | 48.9/50.6 |
Injured side: unknown | 18 | 0.5 |
Trauma mechanism: low-energy/high-energy | 3565/423 | 88.7/10.5 |
Trauma mechanism: unknown | 31 | 0.8 |
Concomitant injury of affected extremity: none/relevant/not relevant | 3137/371/317 | 78.1/9.2/7.9 |
Concomitant injury of affected extremity: unknown | 194 | 4.8 |
Other concomitant injury: none/relevant/not relevant | 2748/534/478 | 68.4/13.3/11.9 |
Other concomitant injury: unknown | 259 | 6.4 |
Fracture pattern: 2-part | 822 | 20.5 |
Fracture pattern: 2-part greater tuberosity | 424 | 10.5 |
Fracture pattern: 2-part lesser tuberosity | 44 | 1.1 |
Fracture pattern: 3-part | 116 | 2.9 |
Fracture pattern: 3-part greater tuberosity | 1348 | 33.5 |
Fracture pattern: 3-part lesser tuberosity | 40 | 1.0 |
Fracture pattern: 4-part | 630 | 15.7 |
Fracture pattern: head split | 144 | 3.6 |
Fracture pattern: 2-part luxation | 126 | 3.1 |
Fracture pattern: 3-part luxation | 45 | 1.1 |
Fracture pattern: 4-part luxation | 93 | 2.3 |
Fracture pattern: luxation with head split | 42 | 1.0 |
Fracture pattern: unknown | 145 | 3.6 |
Table 4.
Description of the therapy. Data for reoperations are not included. RSA—reversed shoulder arthroplasty, HSA—hemi shoulder arthroplasty, n/a—not available.
Table 4.
Description of the therapy. Data for reoperations are not included. RSA—reversed shoulder arthroplasty, HSA—hemi shoulder arthroplasty, n/a—not available.
| Number | Percent of Cases | Percent of Operations |
---|
Treatment: conservative | 1462 | 36.4 | n/a |
Treatment: operation | 2557 | 63.6 | 100.0 |
Treatment: missing values | 0 | 0 | n/a |
Treatment strategy: plate | 1670 | 41.6 | 65.3 |
Treatment strategy: intramedullary nail | 392 | 9.8 | 15.3 |
Treatment strategy: HSA | 51 | 1.3 | 2 |
Treatment strategy: RSA | 299 | 7.4 | 11.7 |
Treatment strategy: screws | 61 | 1.5 | 2.4 |
Treatment strategy: double plate | 38 | 0.9 | 1.5 |
Treatment strategy: missing values | 36 | 0.9 | 1.4 |
Table 5.
Complications after operation (N = 2557). Note that for the special complications documented in Rows 7–17, multiple mentions of a single case are possible.
Table 5.
Complications after operation (N = 2557). Note that for the special complications documented in Rows 7–17, multiple mentions of a single case are possible.
| Number | Percent of Cases | Percent of Complications |
---|
Complications after operation: no | 1439 | 56.3 | n/a |
Complications after operation: yes | 1051 | 41.1 | 100.0 |
Complications after operation: unknown | 67 | 2.6 | n/a |
Complications: only mobility restrictions reported, no reoperation | 440 | 17.2 | 41.9 |
Complications: other cases | 218 | 8.5 | 20.7 |
Complications: at least one of the following problems reported (“special type”) | 393 | 15.4 | 37.4 |
Postoperative infection | 38 | 1.5 | 3.6 |
Screw perforation | 102 | 4.0 | 9.7 |
Implant dislocation | 81 | 3.2 | 7.7 |
Secondary dislocation | 132 | 5.2 | 12.6 |
Luxation of prosthesis | 19 | 0.7 | 1.8 |
Impingement | 53 | 2.1 | 5.0 |
Pseudarthrosis | 28 | 1.1 | 2.7 |
Postoperative nerve damage | 21 | 0.8 | 2.0 |
Peri-implant fracture or new trauma | 29 | 1.1 | 2.8 |
Periprosthetic fracture | 11 | 0.4 | 1.0 |
Humeral head necrosis | 93 | 3.6 | 8.8 |
Reoperation documented at all | 527 | 20.6 | 50.1 |
Early reoperation within 12 months documented | 353 | 13.8 | 33.6 |
Table 6.
Complications after conservative therapy (N = 1462).
Table 6.
Complications after conservative therapy (N = 1462).
| Number | Percent of Cases | Percent of Complications |
---|
Complications: no | 971 | 66.4 | n/a |
Complications: yes | 270 | 18.5 | 100.0 |
Complications: unknown | 221 | 15.1 | n/a |
Complications: neither of special type nor subsequent operation | 78 | 5.4 | 28.9 |
Complications: special type but no subsequent operation | 46 | 3.1 | 17.0 |
Complications: subsequent operation documented | 146 | 10.0 | 54.1 |
Table 7.
Bivariate analysis of risk factors, p-values, and odds ratios. Significant p-values (p ≤ 0.05) are printed in boldface.
Table 7.
Bivariate analysis of risk factors, p-values, and odds ratios. Significant p-values (p ≤ 0.05) are printed in boldface.
Second Covariate | Treatment (Operation): p-Value | Treatment (Operation): Odds Ratio | Second Covariate: p-Value | Second Covariate: Odds Ratio |
---|
Sex: female | <0.0001 | 1.77 | 0.0019 | 0.77 |
Age, binarized: 65 ys. and more | <0.0001 | 1.76 | <0.0001 | 0.70 |
Weight (numeric, 10 kg) | 0.0048 | 0.71 | 0.0010 | 1.08 |
BMI, binarized: 30 kg/m2 and more | 0.0033 | 0.70 | 0.0738 | 1.21 |
ASA class, binarized: class 2 and higher | 0.2764 | 1.12 | 0.3835 | 0.90 |
Comorbidities, binarized: 4 and more | <0.0001 | 1.66 | 0.0290 | 1.22 |
Smoking: yes | <0.0001 | 1.60 | 0.0002 | 1.55 |
Substance abuse: yes | <0.0001 | 1.74 | 0.0119 | 1.42 |
Diabetes mellitus: yes | <0.0001 | 1.64 | 0.9901 | 1.00 |
Immunosuppressive therapy: yes | <0.0001 | 1.68 | 0.3811 | 1.23 |
Living situation, binarized: supervised or nursing home | <0.0001 | 1.93 | 0.7190 | 0.96 |
Injured side: right | <0.0001 | 1.79 | 0.0455 | 1.17 |
Trauma mechanism: high-energy | <0.0001 | 1.77 | 0.2653 | 1.15 |
Concom. injury of affected extremity, binarized: relevant | <0.0001 | 1.76 | 0.3730 | 1.13 |
Fracture pattern, binarized: other than 2-part | <0.0001 | 1.69 | 0.0056 | 1.30 |
Table 8.
Multivariate risk analysis, all feasible models with p ≤ 0.1 in criteria (a) and (b) (N = 11). For the covariates, we use the following abbreviations: AGE—age (binarized), ASA—ASA class (binarized), COMORB—comorbidities (binarized), FRACT—fracture pattern (binarized), SEX—sex, SMOKER—smoking, TREAT—treatment, WEIGHT—weight.
Table 8.
Multivariate risk analysis, all feasible models with p ≤ 0.1 in criteria (a) and (b) (N = 11). For the covariates, we use the following abbreviations: AGE—age (binarized), ASA—ASA class (binarized), COMORB—comorbidities (binarized), FRACT—fracture pattern (binarized), SEX—sex, SMOKER—smoking, TREAT—treatment, WEIGHT—weight.
Model No. | Covariates | Max. Global p-Value | Max. p-Value for Coefficients |
---|
1 | TREAT, FRACT | <0.0001 | 0.0515 |
2 | TREAT, SMOKER | <0.0001 | 0.0100 |
3 | TREAT, WEIGHT | 0.0064 | 0.0454 |
4 | TREAT, AGE | <0.0001 | 0.0017 |
5 | TREAT, AGE, FRACT | <0.0001 | 0.0317 |
6 | TREAT, AGE, COMORB | <0.0001 | 0.0098 |
7 | TREAT, AGE, COMORB, FRACT | <0.0001 | 0.0284 |
8 | TREAT, SEX | <0.0001 | 0.0478 |
9 | TREAT, SEX, FRACT | <0.0001 | 0.0416 |
10 | TREAT, SEX, SMOKER | <0.0001 | 0.0639 |
11 | TREAT, AGE, ASA, TREAT: ASA | 0.0001 | 0.0317 |
Table 9.
Rating of the feasible models by criteria (c)–(f). Covariates are denoted as in
Table 8. AUC: area under the curve; CC: correct classification rate.
Table 9.
Rating of the feasible models by criteria (c)–(f). Covariates are denoted as in
Table 8. AUC: area under the curve; CC: correct classification rate.
Model No. | Covariates | Mean AUC (Train.) | Mean CC Rate (Train.) | Mean AUC (Valid.) | Mean CC Rate (Valid.) |
---|
1 | TREAT, FRACT | 0.7507 | 78.51 | 0.7512 | 78.52 |
2 | TREAT, SMOKER | 0.7744 | 73.66 | 0.7743 | 73.65 |
3 | TREAT, WEIGHT | 0.5679 | 53.37 | 0.5690 | 53.38 |
4 | TREAT, AGE | 0.7339 | 67.55 | 0.7342 | 67.55 |
5 | TREAT, AGE, FRACT | 0.6866 | 67.59 | 0.6870 | 67.59 |
6 | TREAT, AGE, COMORB | 0.6821 | 59.43 | 0.6825 | 59.44 |
7 | TREAT, AGE, COMORB, FRACT | 0.6569 | 56.57 | 0.6567 | 56.57 |
8 | TREAT, SEX | 0.7387 | 70.03 | 0.7387 | 70.03 |
9 | TREAT, SEX, FRACT | 0.6848 | 70.15 | 0.6853 | 70.16 |
10 | TREAT, SEX, SMOKER | 0.7031 | 66.17 | 0.7030 | 66.16 |
11 | TREAT, AGE, ASA, TREAT: ASA | 0.7007 | 53.13 | 0.7004 | 53.12 |
Table 10.
Averaged coefficients for the feasible models. In all models, the order of the covariates is the same as in
Table 8 and
Table 9.
Table 10.
Averaged coefficients for the feasible models. In all models, the order of the covariates is the same as in
Table 8 and
Table 9.
Model No. | Intercept | Coeff_01 | Coeff_02 | Coeff_03 | Coeff_04 | Cutoff |
---|
1 | −1.850232 | 0.524765 | 0.258821 | | | −1.066647 |
2 | −1.728730 | 0.471799 | 0.436402 | | | −1.256932 |
3 | −1.333256 | −0.339794 | 0.078941 | | | −1.061259 |
4 | −1.492157 | 0.569173 | −0.355059 | | | −1.278044 |
5 | −1.645663 | 0.511489 | −0.375351 | 0.284567 | | −1.224960 |
6 | −1.452566 | 0.494375 | −0.440565 | 0.324396 | | −1.288617 |
7 | −1.606725 | 0.428213 | −0.462460 | 0.319434 | 0.297369 | −1.343604 |
8 | 1.519835 | 0.571140 | −0.263775 | | | −1.212472 |
9 | −1.673237 | 0.517943 | −0.273121 | 0.273050 | | −1.428415 |
10 | −1.515743 | 0.470628 | −0.308434 | 0.370138 | | −1.353550 |
11 | −1.469708 | 0.794376 | −0.480485 | 0.738945 | −0.855209 | −1.272083 |
Table 11.
Decision table arising from model no. 1.
Table 11.
Decision table arising from model no. 1.
| Treatment: No OP | Treatment: OP |
---|
Fracture pattern: 2-part | Complications: no | Complications: no |
Fracture pattern: other than 2-part | Complications: no | Complications: yes |