Lee Marcus Josef, Ng Jingwen, Kok Ta Wei Kevin, Kwek Beng Kee Ernest
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Arch Orthop Trauma Surg. 2023 Jan;143(1):353-358. doi: 10.1007/s00402-021-04328-7. Epub 2022 Jan 5.
Elderly patients with concomitant upper limb and hip fractures present a management dilemma because upper limb fractures potentially affect rehabilitation outcomes for the hip fracture. This study aims to evaluate whether the site of upper limb fractures and the decision to surgically treat such fractures affect the functional outcome of surgically treated hip fracture patients.
We retrospectively reviewed 1828 hip fracture patients treated at a single trauma centre over 3 years, of whom 42 with surgically treated hip fractures had concomitant upper limb fractures. Outcome measures, such as length of hospital stay, complications, mortality and readmission rates, were assessed, whilst the functional outcomes were evaluated using the Modified Barthel Index (MBI) on admission, post-operatively and at 6 and 12 months of follow-up.
Amongst the 42 patients with surgically treated hip fractures, 31.0% had proximal humerus fractures, 50.0% had wrist fractures, 16.7% had elbow fractures and 2.4% had forearm fractures. 50.0% of these upper limb fractures were treated surgically. There was no difference in complications, inpatient morbidity, readmission rates or the length of hospital stay for patients whose upper limb fractures were surgically treated as compared to those non-surgically treated. There was no difference in absolute MBI scores at 6 and 12 months based on the management of upper limb fractures. However, patients with surgically treated wrist fractures had statistically significant higher MBI scores at 6 months as compared to those treated non-surgically.
Surgical treatment of concomitant upper limb fractures does not appear to change the outcomes of the hip fractures. Hip fracture patients with surgically treated wrist fractures had better functional outcomes at 6 months compared to those treated non-surgically; however, there was no difference at 12 months. Hip fracture patients with concomitant wrist fractures had better functional outcomes compared to hip fracture patients with proximal humerus fractures.
患有上肢和髋部骨折的老年患者面临治疗难题，因为上肢骨折可能会影响髋部骨折的康复效果。本研究旨在评估上肢骨折的部位以及手术治疗此类骨折的决策是否会影响接受手术治疗的髋部骨折患者的功能结局。
我们回顾性分析了在一个创伤中心3年内接受治疗的1828例髋部骨折患者，其中42例接受手术治疗的髋部骨折患者同时伴有上肢骨折。评估了住院时间、并发症、死亡率和再入院率等结局指标，同时使用改良巴氏指数（MBI）在入院时、术后以及随访6个月和12个月时评估功能结局。
在42例接受手术治疗的髋部骨折患者中，31.0%为肱骨近端骨折，50.0%为腕部骨折，16.7%为肘部骨折，2.4%为前臂骨折。这些上肢骨折中有50.0%接受了手术治疗。与未接受手术治疗的患者相比，接受手术治疗上肢骨折的患者在并发症、住院发病率、再入院率或住院时间方面没有差异。基于上肢骨折的治疗方式，6个月和12个月时的绝对MBI评分没有差异。然而，与未接受手术治疗的患者相比，接受手术治疗腕部骨折的患者在6个月时的MBI评分在统计学上显著更高。
同时进行上肢骨折的手术治疗似乎不会改变髋部骨折的结局。与未接受手术治疗的患者相比，接受手术治疗腕部骨折的髋部骨折患者在6个月时功能结局更好；然而，在12个月时没有差异。与患有肱骨近端骨折的髋部骨折患者相比，伴有腕部骨折的髋部骨折患者功能结局更好。
