title: Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?
abstract: OBJECTIVE
  The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury.
  
  
  METHODS
  Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores.
  
  
  RESULTS
  In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures.
  
  
  CONCLUSIONS
  Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.
authors.affiliation: From the Osteoporosis Research Center and Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo (MDM, CC, FV, RT); and Department of Social Science, University, Torino, Italy (RDM).
authors.forename: Marco
authors.initials: M
authors.lastname: Di Monaco
authors.forename: Carlotta
authors.initials: C
authors.lastname: Castiglioni
authors.forename: Fulvia
authors.initials: F
authors.lastname: Vallero
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Monaco
authors.forename: Rosa
authors.initials: R
authors.lastname: Tappero
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D001134:Arm Injuries / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation*; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D006811:Humerus / Q000293:injuries; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009104:Multiple Trauma / Q000534:rehabilitation*; D016017:Odds Ratio; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012737:Sex Factors; D012784:Shoulder Fractures / Q000534:rehabilitation; D015996:Survival Rate; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000534:rehabilitation