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Does a hip fracture mean we should we operate on a concomitant proximal humerus fracture?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Concomitant upper extremity and hip fractures present a challenge in postoperative mobilization in the geriatric population. Operative fixation of proximal humerus fractures allows for upper extremity weight bearing. This retrospective study compared outcomes between operative and non-operative proximal humerus fracture patients with concomitant hip fractures.

Methods

A trauma database of 13,396 patients age > 55 years old was queried for concomitant hip and proximal humerus fracture patients between 2014–2021. Medical records were reviewed for demographics, hospital quality measures, Neer classification, morphine milligram equivalents (MME), and outcomes. All hip fractures were treated operatively. Patients were grouped based on operative vs. non-operative treatment of their proximal humerus fracture. Primary outcomes included comparing postoperative ambulatory status, pain, length of stay (LOS), intensive care unit (ICU) need, discharge disposition, and readmission rates.

Results

Forty-eight patients (0.4%) met inclusion criteria. Twelve patients (25%) underwent operative treatment for their proximal humerus fracture and 36 (75%) received non-operative treatment. Patients with operative fixations were younger (p < 0.01), had more complex Neer classifications (p = 0.031), more likely to be community ambulators (p < 0.01), and required more inpatient MMEs (p < 0.01). There were no differences in LOS (p = 0.415), need for ICU (p = 0.718), discharge location (p = 0.497), 30-day readmission (p = 0.228), or 90-day readmission (p = 0.135) between cohorts. At 6 months postoperatively, among community or household ambulators, a higher percentage of operative patients returned to their baseline ambulatory functional status, however, this was not significant (70% vs. 52%, p = 0.342). There were three deaths in the non-operative cohort and no deaths in the operative cohort.

Conclusion

Patients with hip fractures and concomitant proximal humerus fractures treated operatively required more inpatient MMEs and trended toward maintaining baseline ambulatory function. There were no differences in inpatient LOS, ICU need, discharge location, or readmissions. Future larger, multicenter studies are needed to further delineate if operative repair of concomitant proximal humerus fractures provides a benefit in the geriatric population.

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Acknowledgements

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA

    Abhishek Ganta, Ariana T. Meltzer-Bruhn, Garrett W. Esper, Sanjit R. Konda & Kenneth A. Egol

  2. Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA

    Abhishek Ganta, Sanjit R. Konda & Kenneth A. Egol

Authors
  1. Abhishek Ganta
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  2. Ariana T. Meltzer-Bruhn
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  5. Kenneth A. Egol
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Corresponding author

Correspondence to Kenneth A. Egol.

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Conflict of interest

There were no conflicts of interest directly pertaining to this study. One author is a paid consultant for Integra Life Sciences. One author receives royalties from PersonaCARE software and is a paid consultant and receives research support from Stryker Orthopedics. One author receives royalties and is a paid consultant for Exactech, receives royalties from Wolters Kluwer, is affiliated with Smith & Nephew, and receives research support from Depuy Synthes (Johnson & Johnson) and Acumed.

Ethical approval

This study was approved by the institutional review board of NYU Langone Health. All methods were carried out in accordance with relevant guidelines and regulations.

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This study was approved by the institutional review board of NYU Langone Health and written informed consent was obtained.

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Ganta, A., Meltzer-Bruhn, A.T., Esper, G.W. et al. Does a hip fracture mean we should we operate on a concomitant proximal humerus fracture?. Eur J Orthop Surg Traumatol 33, 3435–3441 (2023). https://doi.org/10.1007/s00590-023-03529-7

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