Geriatric hip fracture with proximal upper extremity fracture increases morbidity and mortality

Objectives:This study investigates differences in medical, surgical, and hospital-related outcomes within 30 days between patients sustaining a hip fracture with and without concomitant upper extremity fracture. Further subgroup analysis based on fracture location was also completed.MethodsDesign:Retrospective review.Setting:National Readmissions Database.Patient Selection Criteria:International Classification of Diseases, 10th Revision codes were used to identify patients with geriatric hip fracture with and without a concomitant upper extremity fracture. Patients were subclassified as having a shoulder girdle, humerus, forearm, or hand fracture.Outcomes:Demographics, complications, cost, and in-house mortality were recorded. Validated logistic and linear regression models were used to determine significance and odds ratios.Results:367,007 patients sustained a hip fracture, and 19,852 had a concomitant upper extremity fracture. Aggregate data for hip fracture with any upper extremity fracture showed an increased risk of mortality, length of hospital stay, cost, and medical and surgical complications (P < 0.001). There was a 41% increase in mortality across all upper extremity fractures, a 77%-83% increase in in-hospital mortality with a concomitant proximal upper extremity fracture (humerus and shoulder), and no significant change in mortality in the forearm and hand subgroup (P < 0.001). Concomitant shoulder and humerus fractures had an increased risk of all-cause medical and medical complication (P < 0.001).Conclusions:This study reported an increased risk of mortality, complications, and cost of geriatric hip fractures with concomitant upper extremity fracture. Subgroup analysis demonstrated that these effects were most pronounced in proximal - versus more distal - upper extremity fractures. Surgeons should be aware of these increased risks for prognostic and patient education purposes and, with future research, may consider alternate interventions, to include surgery on the concomitant proximal upper extremity injury aimed at producing a functional and weight-bearing upper extremity to help optimize postoperative recovery.