Concomitant Upper Extremity Fracture Worsens Outcomes in Elderly Patients With Hip Fracture

Abstract

Background:Elderly patients with low-energy hip fractures have high rates of morbidity and mortality, but it is not well known how often concurrent upper extremity fractures occur and how this impacts outcomes. We used the National Trauma Databank (NTDB), the largest aggregation of US trauma registry data available, to determine whether patients with concurrent upper extremity and hip fractures have worse outcomes than patients with hip fractures alone.Methods:We accessed the NTDB to identify patients aged 65 to 100 who sustained a hip fracture. The cohort was then narrowed to include only patients who sustained their injury in a fall and had an injury severity score indicating hip fracture as the most severe injury. We then analyzed this group to assess the impact of a simultaneous upper extremity fracture on length of stay, in-hospital mortality, and discharge disposition.Results:From 2007 to 2014, a total of 231,299 patients aged 65 to 100 were identified as having a hip fracture. The narrowed cohort with fall as the mechanism and hip fracture as the most severe injury included 193,862 patients. Of these, 12,618 patients sustained a concomitant upper extremity fracture (6.5%). Compared to isolated hip fractures, patients with a concomitant upper extremity fracture had higher odds of death in the hospital (odds ratio [OR] = 1.3; 95% confidence interval = 1.2-1.4), were less likely to be discharged to home as compared to a skilled facility (OR = 0.73; 95% confidence interval = 0.68-0.78), and had a significantly longer average length of stay (7.1 vs 6.4 days, P < .001).Conclusions:We found a 6.5% prevalence of concomitant upper extremity fractures in patients aged 65 to 100 with a hip fracture sustained after a fall where the hip fracture was the most severe injury. These patients had a higher risk of in-hospital mortality, were less likely to be discharged to home, and had longer average length of stay.

Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study

“…However, for concomitant injuries in other body regions it could only be shown that these usually lead to a longer hospital stay, which is associated with a higher mortality rate in elderly patients in particular. Generally, this had no influence on the outcome of the examined injury [44, 45]. In contrast, in our study, the concomitant injuries, secondary to the reduction result, showed a negative influence on four of the evaluated outcome parameters.…”

Injury specific trauma registry: Outcomes of a prospective cohort with proximal femur fractures

“…In our study, the most common mechanism of IT and NOF fractures was fall (92%) supporting previously published studies with increasing risk in elderly at age of 60 years or more [12].…”

Simultaneous Hip and Distal Radius Fractures—Does It Make a Difference with Respect to Rehabilitation?

“…Moreover, our study revealed no difference regarding any outcome measure between the two observed groups at discharge and 4 months postoperatively. Previous studies reported a higher proportion of females in the multiply injured group [2,6] Most authors investigating survivorship in patients with combined upper extremity and hip fractures showed no statistically significant increased short-and long-term mortality when compared with patients with isolated hip fracture [1,2,4,7]. Moreover, two groups of authors showed a trend towards lower 1 year mortality for patients with a simultaneous wrist fracture [2,4].…”

“…Moreover, two groups of authors showed a trend towards lower 1 year mortality for patients with a simultaneous wrist fracture [2,4]. However, Thayer et al, who investigated concomitant upper extremity fractures in older people with hip fracture, found a higher risk of in-hospital mortality rates [6].…”

“…The results of the existing studies are conflicting as well. While some studies report longer hospital stay [6], higher in-hospital mortality rates [2,6], and a less likelihood to be discharged home [6], others show favorable outcomes in this group of patients [1,2,4,5,7]. The aim of our study is to prospectively compare functional outcomes and survival between patients with combined hip and wrist fractures and those with isolated hip fractures.…”