The Impact of Concomitant Upper Extremity Fractures on Outcomes in Geriatric Patients Following Hip Fracture Surgery

Background: Hip fractures in geriatric patients represent a major public health burden, with a clinically important subset presenting with concomitant upper extremity (UE) fractures. The independent impact of these dual injuries on clinical outcomes remains incompletely characterized. Methods: A retrospective study of patients aged ≥65 years who underwent surgical treatment for hip fracture at tertiary medical center, between January 2010 and January 2024. Patients were stratified based on the presence of a UE fracture sustained at the same time as the hip fracture. Multivariable regression models were used to assess outcomes, adjusting for age, sex, hip fracture type, and comorbidity burden. Primary outcomes were hospital length of stay and mortality at 30 days and 1 year. Secondary outcomes included readmission rates, revision surgery, and infection complications. Results: Of 7488 patients, 251 (3.4%) had concomitant upper extremity (UE) fractures. These patients had a longer mean hospital stay compared with isolated hip fractures (20.2 vs. 17.5 days, p = 0.047), with no significant difference in 30-day mortality (p = 0.439) and a trend toward lower 1-year mortality (p = 0.058). In the concomitant UE fracture group, operative treatment was associated with longer hospitalization (26.2 vs. 19.2 days, p = 0.05) and higher revision surgery rates (14.0% vs. 3.1%, p = 0.01). Subgroup analyses by fracture type showed similar trends, with longer hospital stays observed in intracapsular fractures with concomitant injury (p = 0.05). Subgroup analysis by UE fracture location showed significantly longer stays for distal radius fractures compared with isolated hip fractures, whereas no significant differences were observed for proximal humerus or other UE fracture locations. Conclusions: Concomitant UE fractures in geriatric hip fracture patients are associated with prolonged hospitalization. Operative management of UE fractures results in longer hospital stays and an increased risk of revision surgery. These findings highlight the importance of tailored perioperative planning and resource allocation for this vulnerable patient group.