Does the surgical treatment of concomitant upper limb fractures affect the outcomes of hip fractures in the elderly population?

• Published in: Archives of orthopaedic and trauma surgery 2023-01, Vol.143 (1), p.353-358
• Main Authors: Lee, Marcus Josef, Ng, Jingwen, Kok, Ta Wei Kevin, Kwek, Beng Kee Ernest
• Format: Article
• Language: English
• Subjects: Aged; Arm Injuries; Fractures; Hip Fractures - complications; Hip Fractures - epidemiology; Hip Fractures - surgery; Humans; Humeral Fractures - complications; Length of stay; Medicine; Medicine & Public Health; Older people; Orthopedics; Retrospective Studies; Shoulder Fractures; Trauma Surgery; Treatment Outcome; Upper Extremity; Wrist Injuries - complications
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-021-04328-7

Introduction Elderly patients with concomitant upper limb and hip fractures present a management dilemma because upper limb fractures potentially affect rehabilitation outcomes for the hip fracture. This study aims to evaluate whether the site of upper limb fractures and the decision to surgically treat such fractures affect the functional outcome of surgically treated hip fracture patients. Methodology We retrospectively reviewed 1828 hip fracture patients treated at a single trauma centre over 3 years, of whom 42 with surgically treated hip fractures had concomitant upper limb fractures. Outcome measures, such as length of hospital stay, complications, mortality and readmission rates, were assessed, whilst the functional outcomes were evaluated using the Modified Barthel Index (MBI) on admission, post-operatively and at 6 and 12 months of follow-up. Results Amongst the 42 patients with surgically treated hip fractures, 31.0% had proximal humerus fractures, 50.0% had wrist fractures, 16.7% had elbow fractures and 2.4% had forearm fractures. 50.0% of these upper limb fractures were treated surgically. There was no difference in complications, inpatient morbidity, readmission rates or the length of hospital stay for patients whose upper limb fractures were surgically treated as compared to those non-surgically treated. There was no difference in absolute MBI scores at 6 and 12 months based on the management of upper limb fractures. However, patients with surgically treated wrist fractures had statistically significant higher MBI scores at 6 months as compared to those treated non-surgically. Conclusion Surgical treatment of concomitant upper limb fractures does not appear to change the outcomes of the hip fractures. Hip fracture patients with surgically treated wrist fractures had better functional outcomes at 6 months compared to those treated non-surgically; however, there was no difference at 12 months. Hip fracture patients with concomitant wrist fractures had better functional outcomes compared to hip fracture patients with proximal humerus fractures.