Predictors of Mortality in Elder Patients With Proximal Humeral Fracture
نویسندگان
چکیده
Background Known possible consequences of proximal humerus fractures include impaired shoulder function, decreased independence, and increased risk for mortality. The purpose of this report is to describe the survival and independence of elderly patients with fractures of the proximal humerus, treated in our institution, relative to patient characteristics and treatment method. Methods Retrospective cohort study from 2006 to 2012. Setting Community-based hospital with level 1 designation. Patients/Participants Three hundred nineteen patients ≥60 years who presented to the emergency department with an isolated fracture of the proximal humerus were either admitted to the inpatient ward for the organization and provision of immediate definitive care or discharged with the expectation of coordination of their care as an outpatient. Treatment was nonoperative or operative. Outcome Measures One- and 2-year mortality. Results Significant predictors of mortality at 1 year included Charlson Comorbidity Index (CCI; continuous, hazard ratio [HR] = 1.40; 95% confidence interval [CI]: 1.06-1.86), body mass index (BMI; <25 vs ≥25; HR = 3.43; 95% CI: 1.45-8.14), and American Society of Anesthesiologists (ASA) disease severity score (3-4 vs 1-2; HR = 4.48; 95% CI: 1.21-16.55). In addition to CCI and BMI, reliance on a cane/walker/wheelchair at the time of fracture predicted mortality at 2 years (vs unassisted ambulation; HR = 3.13; 95% CI: 1.59-5.88). Although the Neer classification of fracture severity significantly correlated with inpatient admission (P < .001), it was not significantly associated with mortality or with loss of living or ambulatory independence. Among admitted patients, 64% were discharged to a facility with a higher level of care than their prefracture living facility. Twenty percent of study patients experienced a loss in ambulatory status by at least 1 level at 1 year postfracture. Conclusion In a cohort of elderly patients with fractures of the proximal humerus, patient characteristics including comorbidities, ASA classification, and lower BMI were associated with increased mortality. Specifically, those admitted at the time of fracture and treated nonoperatively had the highest mortality rate and, likely, represent the frailest cohort. Those initially treated as outpatients and later treated operatively had the lowest mortality and, likely, represent the healthiest cohort. These data are inherently biased by prefracture comorbidities but help stratify our patients' mortality risk at the time of injury.
منابع مشابه
Comparison of Minimally Invasive Percutaneous Plate Osteosynthesis and Open Reduction Internal Fixation on Proximal Humeral Fracture in Elder Patients: A Systematic Review and Meta-Analysis
OBJECTIVE The study aims to compare minimally invasive percutaneous plate osteosynthesis (MIPO) and open reduction internal fixation (ORIF) in the treatment of proximal humeral fracture in elder patients. METHOD PubMed, Medline, EMbase, Ovid, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wangfang, and VIP Database for Chinese Technical Periodicals were searched to identify...
متن کاملOperative Treatment of Proximal Humeral Fracturedislocations Through an Anterolateral Deltoid Split Approach
Background: Proximal humeral fracture-dislocations (PHFD) are a special entity in proximal humeral fracturetreatment. The aim of this study is to present our minimally invasive plate osteosynthesis (MIPO) technique throughan anterolateral deltoid split approach. In addition, we performed a retrospective cohort study analyzing the patientreported functional outcome and complica...
متن کاملThe Outcome of Proximal Humeral Locking Plates in the Management of Three and Four Part Proximal Humeral Fractures in Special Cohort of Young Patients in High Velocity Trauma
Background: Locking plate fixation provides satisfactory outcome following proximal humerus fractures. None of theprevious studies selectively evaluate the outcome in young patients. This study evaluates outcome of locking platesystem in the treatment of acute three- and four-part fractures in young patients.Methods: In this prospective study we included all patients who were less than 60 years...
متن کاملWing amputation in a Golden eagle with humeral fracture
Case Description-An adult golden eagle with a wound on its right wing caused by gunshot was presented to the University of Tabriz, Veterinary Teaching Hospital. Clinical Finding-Clinical examination and radiographs, revealed compound fracture in distal third of humerus, severe soft tissue compromise and irreparable loss of blood supply. Anemia and leukocy...
متن کاملAcute Combined Median and Radial Nerve Palsies after Distal Humeral Shaft Fracture
We report a case of a 29-year-old man who presented with a distal humeral shaft fracture sustained by blunt trauma. Physicalexamination and nerve conduction study were consistent with injury to the median and radial nerves proximal to theelbow. The patient underwent open reduction and internal fixation of the humeral shaft fracture with neurolysis of the medianand radial nerves. Repeat electrom...
متن کاملTrends in incidence of proximal humerus fractures, surgical procedures and outcomes among elderly hospitalized patients with and without type 2 diabetes in Spain (2001–2013)
BACKGROUND Several studies have reported that diabetic persons have an increased risk for fractures than non-diabetes patients. The association between proximal humerus fractures and type 2 diabetes (T2DM) is unclear and some studies point to insulin treatment, hypoglycaemic episodes consequently to inadequate control of diabetes or, more recently, to an alteration of trabecular bone. We examin...
متن کامل