Concomitant upper limb and hip fractures in older adults - does the site matter? A retrospective clinical observation study

Background: Recent reports have suggested that mortality and morbidity in patients with concomitant upper limb and hip fractures vary depending on the sites of fracture. Objectives: To determine the mortality outcomes in elderly patients with concomitant upper limb (wrist or humerus) and hip fractures compared to patients with isolated hip fractures. The secondary objective was to determine the length of hospital stay during acute care, morbidity characteristics and perioperative complication rates. Methods: 144 older adults with concomitant upper limb and hip fractures were compared to 2,690 older adults with isolated hip fractures in a single-centre tertiary hospital. Blinded patient data were extracted from our Inpatient Separation Information System based on ICD-10 codes for analysis and comparison between the groups. A multivariate regression survival analysis was performed to determine mortality outcomes. Results: No difference in mortality was shown between patient groups in the short and long term. Older adults with concomitant humeral and hip fractures had a higher prevalence of cognitive disorders and chronic kidney disease, while those with concomitant wrist and hip fractures had the lowest. Those with concomitant upper limbs fracture had a longer length of stay during the acute care, as well as a greater requirement for blood transfusions. Conclusions: When compared to isolated hip fracture patients, older adults with concomitant hip and humeral fractures may represent a frailer group, but not necessary in those with concomitant hip and wrist fractures.