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Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Combined hip and upper-extremity fractures raise clinical concerns because upper-extremity fractures may hinder early mobilization, thereby affecting rehabilitation and mortality. This systematic review and meta-analysis aimed to evaluate the effects of combined upper-extremity and hip fractures on rehabilitation and mortality.

Materials and methods

We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published before March 20, 2022, that evaluated the impact of concomitant upper-extremity injuries in geriatric patients with hip fractures. The pooled analysis identified differences in the (1) length of hospital stay, (2) discharge destination, and (3) mortality rates between the isolated and combined hip fracture groups.

Results

A total of 217,233 patients with isolated hip fractures (n = 203,816) and combined hip and upper-extremity fractures (n = 13,417) from 12 studies were analyzed. The average length of hospital stay was significantly longer in the combined upper-extremity fracture group than in the isolated hip fracture group (mean difference = 1.67 days; 95% confidence interval [CI] 0.63–2.70; P = 0.002). Patients in the combined upper limb fracture group were less likely to be discharged directly home (odds ratio [OR] = 0.64; 95% CI 0.52–0.80; P < 0.001) and showed significantly higher 30-day mortality (OR = 1.44; 95% CI 1.32–1.58; P < 0.001). The mortality rate after 30 days was not significantly different between the two groups.

Conclusions

Concomitant upper-extremity fractures have debilitating effects on rehabilitation and early mortality in geriatric patients with hip fractures. Therefore, more focus should be placed on the early ambulation of patients with hip fractures and simultaneous upper limb fractures to promote rehabilitation and alleviate the public health burden.

Level of evidence

III meta-analysis.

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References

  1. Cheung CL, Ang SB, Chadha M, Chow ES, Chung YS, Hew FL, Jaisamrarn U, Ng H, Takeuchi Y, Wu CH, Xia W, Yu J, Fujiwara S (2018) An updated hip fracture projection in Asia: the Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4:16–21. https://doi.org/10.1016/j.afos.2018.03.003

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43:676–685. https://doi.org/10.1016/j.injury.2011.05.017

    Article  PubMed  Google Scholar 

  3. Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 166:766–771. https://doi.org/10.1001/archinte.166.7.766

    Article  PubMed  PubMed Central  Google Scholar 

  4. Heiden JJ, Goodin SR, Mormino MA, Siebler JC, Putnam SM, Lyden ER, Tao MA (2021) Early ambulation after hip fracture surgery is associated with decreased 30-day mortality. J Am Acad Orthop Surg 29:e238–e242. https://doi.org/10.5435/jaaos-d-20-00554

    Article  PubMed  Google Scholar 

  5. Buecking B, Wack C, Oberkircher L, Ruchholtz S, Eschbach D (2012) Do concomitant fractures with hip fractures influence complication rate and functional outcome? Clin Orthop Relat Res 470:3596–3606. https://doi.org/10.1007/s11999-012-2419-z

    Article  PubMed  PubMed Central  Google Scholar 

  6. Robinson PM, Harrison T, Cook A, Parker MJ (2012) Orthopaedic injuries associated with hip fractures in those aged over 60 years: a study of patterns of injury and outcomes for 1971 patients. Injury 43:1131–1134. https://doi.org/10.1016/j.injury.2012.03.012

    Article  CAS  PubMed  Google Scholar 

  7. Schoeneberg C, Pass B, Oberkircher L, Rascher K, Knobe M, Neuerburg C, Lendemans S, Aigner R (2021) Impact of concomitant injuries in geriatric patients with proximal femur fracture: an analysis of the Registry for Geriatric Trauma. Bone Jt J 103-b:1526–1533. https://doi.org/10.1302/0301-620x.103b9.Bjj-2021-0358.R1

    Article  Google Scholar 

  8. Uzoigwe CE, Venkatesan M, Johnson N, Lee K, Magaji S, Cutler L (2015) Influence of coincident distal radius fracture in patients with hip fracture: single-centre series and meta-analysis. J Orthop Traumatol 16:93–97. https://doi.org/10.1007/s10195-013-0281-8

    Article  CAS  PubMed  Google Scholar 

  9. Dubljanin-Raspopović E, Lj MD, Kadija M, Tomanović Vujadinović S, Tulić G, Selaković I, Aleksić M (2019) Simultaneous hip and distal radius fractures-does it make a difference with respect to rehabilitation? Geriatrics (Basel). https://doi.org/10.3390/geriatrics4040066

    Article  PubMed  Google Scholar 

  10. Haque A, Singh HP (2020) Mortality following combined fractures of the hip and proximal humerus. World J Orthop 11:426–430. https://doi.org/10.5312/wjo.v11.i10.426

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kang SW, Shin WC, Moon NH, Suh KT (2019) Concomitant hip and upper extremity fracture in elderly patients: Prevalence and clinical implications. Injury 50:2045–2048. https://doi.org/10.1016/j.injury.2019.09.010

    Article  PubMed  Google Scholar 

  12. Lin YP, Hung SH, Su YP, Feng CK, Liu CL, Chiu FY (2015) Concomitant hip and distal radius fractures. J Chin Med Assoc 78:304–307. https://doi.org/10.1016/j.jcma.2014.12.005

    Article  PubMed  Google Scholar 

  13. Morris DLJ, Nightingale JM, Geoghegan JM, Moran CG (2020) Concurrent upper limb and hip fracture in the elderly. Injury 51:1025–1030. https://doi.org/10.1016/j.injury.2020.02.073

    Article  Google Scholar 

  14. Ng A, Mattin A, Seymour H, McKinnon E (2019) Comparison of outcomes between hip fracture patients with concurrent upper limb injuries and patients with an isolated hip fracture. ANZ J Surg 89:57–60. https://doi.org/10.1111/ans.14942

    Article  PubMed  Google Scholar 

  15. Siaw VWS, Kim S, Hakendorf P, Horwood C, To T (2017) Concomitant upper limb and hip fractures in older adults—does the site matter? A retrospective clinical observation study. J Clin Gerontol Geriatr 8:47–51. https://doi.org/10.24816/jcgg.2017.v8i2.02

    Article  Google Scholar 

  16. Thayer MK, Kleweno CP, Lyons VH, Taitsman LA (2018) Concomitant upper extremity fracture worsens outcomes in elderly patients with hip fracture. Geriatr Orthop Surg Rehabil. https://doi.org/10.1177/2151459318776101

    Article  PubMed  PubMed Central  Google Scholar 

  17. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, Group P-P (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10. https://doi.org/10.1186/1471-2288-7-10

    Article  PubMed  PubMed Central  Google Scholar 

  19. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  20. Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2022) Cochrane handbook for systematic reviews of interventions version 6.3 Cochrane. www.training.cochrane.org/handbook. Accessed 30 Mar 2022

  21. Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R (2015) Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter? Am J Phys Med Rehabil/Assoc Acad Physiatr 94:366–372. https://doi.org/10.1097/PHM.0000000000000191

    Article  Google Scholar 

  22. Mulhall KJ, Ahmed A, Khan Y, Masterson E (2002) Simultaneous hip and upper limb fracture in the elderly: incidence, features and management considerations. Injury 33:29–31. https://doi.org/10.1016/s0020-1383(01)00097-3

    Article  PubMed  Google Scholar 

  23. Rotter T, Kinsman L, James EL, Machotta A, Gothe H, Willis J, Snow P, Kugler J (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006632.pub2

    Article  PubMed  Google Scholar 

  24. Lee KJ, Um SH, Kim YH (2020) Postoperative rehabilitation after hip fracture: a literature review. Hip Pelvis 32:125–131. https://doi.org/10.5371/hp.2020.32.3.125

    Article  PubMed  PubMed Central  Google Scholar 

  25. Goubar A, Martin FC, Potter C, Jones GD, Sackley C, Ayis S, Sheehan KJ (2021) The 30-day survival and recovery after hip fracture by timing of mobilization and dementia: a UK database study. Bone Jt J 103-b:1317–1324. https://doi.org/10.1302/0301-620x.103b7.Bjj-2020-2349.R1

    Article  Google Scholar 

  26. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ (2006) No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg 76:607–611. https://doi.org/10.1111/j.1445-2197.2006.03786.x

    Article  PubMed  Google Scholar 

  27. Tow BPB, Chua BSY, Fook-Chong S, Howe TS (2009) Concurrent fractures of the hip and wrist: a matched analysis of elderly patients. Injury 40:385–387. https://doi.org/10.1016/j.injury.2008.09.013

    Article  PubMed  Google Scholar 

  28. Ferris H, Brent L, Coughlan T (2020) Early mobilisation reduces the risk of in-hospital mortality following hip fracture. Eur Geriatr Med 11:527–533. https://doi.org/10.1007/s41999-020-00317-y

    Article  PubMed  Google Scholar 

  29. Haddaway NR (2015) A call for better reporting of conservation research data for use in meta-analyses. Conserv Biol 29:1242–1245. https://doi.org/10.1111/cobi.12449

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea

    Han Soul Kim, Jung Eun Lee & Rak Jun Choi

  2. Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 06973, Republic of Korea

    Chul-Ho Kim

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Kim, H.S., Lee, J.E., Choi, R.J. et al. Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 143, 3795–3802 (2023). https://doi.org/10.1007/s00402-022-04608-w

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