Proximal humerus fractures (PHFs), Achilles tendon ruptures (ATRs), and hip fractures are common orthopedic traumas that have been the focus of increasing clinical research in recent decades. Comparative evidence favors nonoperative treatment for PHFs and ATRs, while arthroplasty with cemented stems is recommended for most femoral neck fractures. Arthroplasty has also become more widely studied in PHF management.

The aim of this doctoral thesis was to examine changes in the incidence and treatment of these injuries in Finland over the past two decades, with emphasis on how treatment practices have adapted to emerging evidence-based medicine. Data were obtained from the National Hospital Discharge Register and the National Register of Primary Health Care Visits.

The findings show that the incidence of PHFs and ATRs has risen, whereas hip fracture incidence has remained relatively stable. There has been a clear, evidencebased shift toward nonoperative management of PHFs and ATRs, and for femoral neck fractures, from internal fixation (IF) to cemented arthroplasty. In trochanteric fractures, the dynamic hip screw has been largely replaced by cephalomedullary nails. In operative treatment of PHFs, reverse shoulder arthroplasty has become more common in relation to IF and hemiarthroplasty. These changes parallel international trends, despite a lower level of evidence in their favor. A strong national consensus amongst hospital districts was also evident in PHF treatment.

These injuries impose a substantial health and economic burden. Awareness of national incidence trends is crucial for planning health care resources, and treatment must be both standardized and effective, particularly given the challenges of the ongoing Finnish health care reform. In this field of orthopedic trauma, Finnish treatment practices have, with good consensus, developed in the right direction as defined by current medical scientific evidence.