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Del Baño-Barragán L, Martínez-García Á, Garríguez-Pérez D, Mora-Fernández J, García-Coiradas J, Valle-Cruz JA, Marco F. Concurrent uper limb and hip fracture in the elderly: experience at our centre. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00089-4. [PMID: 38851565 DOI: 10.1016/j.recot.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/28/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION The incidence of hip fracture in the elderly is on the rise, occasionally accompanied by concurrent upper limb fractures. Our investigation aims to determine whether these patients experience poorer functional outcomes, prolonged hospitalization, or higher mortality rates when compared to those with isolated hip fracture. MATERIAL AND METHODS We retrospectively reviewed 1,088 elderly patients admitted to our centre with hip fracture between January 2017 and March 2020. We recorded the presence of concomitant fractures and their treatment. We analyzed the duration of hospital stay, in-hospital mortality and function. RESULTS We identified 63 patients with concomitant upper limb fracture (5.6%). Among them, 93.7% were women, and the average age was 86.4 years. 80.9% of the upper limb fractures were distal radius or proximal humerus. Patients with concomitant fracture had increased length of stay (mean, 19.6 vs, 12.8, p=0.002), decreased proportion of patients returning to their own home at discharge (23.6% vs, 26.3%, p=0.042) and increased in-hospital mortality rate (9.5% vs, 5.9%, p=0.003). CONCLUSIONS Patients with concomitant upper limb fracture require a longer length of stay and exhibit an elevated in-hospital mortality rate. Furthermore, this condition is associated with a reduced short-term functional recovery, thereby decreasing the chances of the patient returning home upon hospital discharge.
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Affiliation(s)
- L Del Baño-Barragán
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España.
| | - Á Martínez-García
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España
| | - D Garríguez-Pérez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España
| | - J Mora-Fernández
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España
| | - J García-Coiradas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España
| | - J A Valle-Cruz
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Ortogeriatría, Hospital Clínico San Carlos, Madrid, España
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Postler A, Posten C, Schubert M, Beyer F, Lützner J, Vicent O, Kleber C, Goronzy J, Kamin K. Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital. BMC Geriatr 2024; 24:130. [PMID: 38310209 PMCID: PMC10838409 DOI: 10.1186/s12877-024-04733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Despite improving the management of proximal femur fractures (PFF) with legal requirements of timing the surgery within 24 h, mortality rates in these patients remain still high. The objective of our study was to analyze potential cofactors which might influence the mortality rate within 90 days after surgery in PFF to avoid adverse events, loss of quality of life and high rates of mortality. METHODS In this retrospective, single-center study all patients with PFF aged 65 years and older were included. We recorded gender, age, type of fracture, surgery and anesthesia, time, comorbidities and medication as well as complications and mortality rate at 90 days. Separate logistic regression models were used to assess which parameters were associated with patients' mortality. The mortality rate was neither associated with timing, time and type of surgery nor time and type of anesthesia, but with higher age (OR 1.08 per year; 95% CI 1.034-1.128), lower BMI (OR 0.915 per kg/m2; 95% CI 0.857-0.978), higher CCI (OR 1.170 per point; 95% CI 1.018-1.345), dementia (OR 2.805; 95% CI 1.616-4.869), non-surgical complications (OR 2.276; 95% CI 1.269-4.083) and if mobilization was impossible (OR 10.493; 95% CI 3.612-30.479). RESULTS We analyzed a total of 734 patients (age ≥ 65 years) who had a PFF in 2019 and 2020 and received surgery. 129 patients (17.6%) died until 90 days at an median age of 89.7 years (range 65-101 years). CONCLUSION The proportion of patients who died until 90 days after surgery is still high. It is less extend influenced by surgical and anaesthesiologic factors than by patient-related factors like age or lower BMI. Physicians should be aware of the importance of avoiding adverse events and the importance of patients' mobilization to reduce mortality and improve patients' outcome.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Charlotte Posten
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Melanie Schubert
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Oliver Vicent
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christian Kleber
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Jens Goronzy
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Konrad Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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