Does the combination of a simultaneous subcapital fracture of humerus and hip fracture in elderly patients carry a prognostic value?
The most important factor to cause hip fractures in elderly is probably osteoporosis. Other factors are the increase in fall frequency and the protective response to trauma. Osteoporotic fractures occur most commonly, at the hip, vertebra, distal radius and proximal humerus. A combination of these is uncommon. Thirty-two women and six men treated between January 1990 and December 1999 for a combination of subcapital fracture of the humerus and hip fractures were evaluated retrospectively. The following parameters were reviewed: age, sex, pre-fall function, use of drugs, chronic and acute comorbidity, circumstances of the fall, length of hospitalization, treatment procedure, complications and post-hospitalization rehabilitation. Group I consisted of 15 patients aged 70-80 years and group II consisted of the remaining 23 patients, older than 80 years. In all 38 patients the simultaneous fractures were ipsilaterally. Hospital stay ranged from 7 to 17 days for the discharged 37 patients. Twenty-six of 28 patients, who were transferred to a rehabilitation center, returned to their previous activity of daily living (ADL). Among the nine remaining patients only five gained full recovery. A combination of fractures, occurs in the higher-age group, is quite traumatic to the patient and probably involves a greater impact force. In all patients it occurs in the ipsilateral side. In the elderly, even a minimal transmission to the osteoporotic hip can cause a fracture. The double trauma represents a better pre-morbid condition relative to patients in the same age group, thus it may serve as a prognostic indicator for success in rehabilitation.
Shabat
Shay
S
Department of Orthopedic Surgery, Sapir Medical Center, and Tel-Aviv Sourasky Medical School, 48 Tchernichovsky St, Kfar-Saba 44281, Israel. drshabat@hotmail.com
Gepstein
Reuben
R
Mann
Gideon
G
Kish
Benjamin
B
Stern
Avi
A
Fredman
Brian
B
Nyska
Meir
M