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Upper limb fragility fractures more likely associated with hip fractures
Researchers also found that patients with hip and humeral fractures had higher mortality rates than those with solitary hip fractures.
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One of the largest published studies on simultaneous hip and upper limb fragility fractures shows that upper limb fractures are more likely to occur with hip fractures than lower limb fractures.
“Simultaneous lower limb fractures with a hip fracture are rare,” Paul Robinson, MRCS, MBChB (Hons), BMedSci, said of his group’s findings during a presentation at the 12th EFORT Congress 2011. Robinson and his colleagues also found that patients with an upper limb fracture associated with a hip fracture had longer hospital stays, but better mental function than those with solitary hip fractures.
“There was a tendency for those with an associated humeral fracture to be frailer and have a much higher mortality rate than those with a [solitary] hip fracture,” Robinson added.
To document the orthopedic injuries that occur in association with a hip fracture and to investigate the incidence, patterns of injury and outcomes of these injuries, Robinson and colleagues prospectively studied 1,971 hip fractures that occurred in patients older than 60 years who underwent treatment at a single center between 2004 and 2010. Patients with rib, vertebral and soft tissue fractures were excluded from the study.
Location of fractures
Of these hip fractures, 81 (4.1%) had associated injuries. The investigators identified 73 hip and upper limb fractures, six hip and lower limb fractures, and two patients with combined upper and lower limb fractures associated with a hip fracture.
“Pubic rami fractures were not seen in our series,” Robinson said.
Among the upper limb injuries, were 34 wrist fractures, 21 proximal humerus fractures and three shoulder dislocations.
“The great majority of these were on the ipsilateral side to the hip fracture,” Robinson said.
Female patients with a hip fracture and associated wrist fracture outnumbered male patients at a ratio of almost 6:1.
Mortality rates
The investigators found that patients with upper limb and hip fractures had similar mean ages and American Society of Anesthesiologists (ASA) grades compared to those with a solitary hip fracture.
However, they found that patients with combined hip and upper limb fractures had significantly longer hospital stays and better mental scores.
A comparison of patients with solitary hip fractures to those with associated wrist fractures showed similar mobility scores, but higher mental health scores in those with wrist fractures. However, these patients had lower 1-year mortality rates than those with solitary hip fractures (19% vs. 29%).
Patients with associated humeral fractures had the longest median hospital stay at 24 days. “Importantly, they had a much higher mortality rate at all time points when compared with a solitary hip fracture — double the mortality rate of 30 days — and this trend continues at 1 year,” Robinson said.
Humeral and wrist fractures
The investigators also compared patients with hip and humeral fractures to patients with hip and wrist fractures. Although both groups had similar mean metal and mobility scores, Robinson reported that patients with associated humeral fractures had almost double the 30-day mortality rate and a much higher 1-year mortality rate.
“Humerus fractures also represented a physiologically frailer patient having a higher median ASA grade of 3 compared to ASA 2 for simultaneous wrist fractures,” Robinson said. – by Renee Blisard
Reference:
- Robinson P, Harrison T, Cook A, Parker M. Patterns of injury and outcomes in simultaneous hip and upper limb fragility fractures. Paper #1898. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.
- Paul Robinson, MRCS, MBChB (Hons), BmedSci, can be reached at Peterborough City Hospital Edith Cavell Campus, Bretton Gate, Bretton, Peterborough, Cambridgeshire, PE3 9GZ England; 01733 678000; email: paulrobinson79@doctors.org.uk.
- Disclosure: Robinson has no relevant financial disclosures.