Major Upper-Extremity Fractures in Older Adults: Predictors of 5-Year Mortality

To estimate 5-year mortality after major upper-extremity fractures in adults aged ≥65 years and to identify clinical and fracture-related factors associated with mortality.

We conducted a retrospective single-center study of adults aged ≥65 years who presented between 2014 and 2020 with a suspected major upper-extremity fracture. Fracture diagnoses were confirmed on archived radiographs and analyzed by index diagnosis and by anatomic region. Candidate factors included age, sex, comorbidity burden (age-adjusted Charlson Comorbidity Index [aCCI] categories), presence of concomitant fractures outside the upper extremity, injury mechanism (low- vs high-energy), upper-extremity fracture multiplicity, and treatment type (operative vs nonoperative). Five-year mortality was the primary outcome.

A total of 1,240 patients were included (median age 73 years; 67.3% female) with a median follow-up of 6.0 years. Five-year mortality was 28.2% (95% CI 25.7-30.8). Mortality differed by fracture location, lowest after wrist-region fractures (especially distal radius) and highest after arm-region fractures (especially humeral shaft). Mortality increased with age and was higher in men. Concomitant fractures outside the upper extremity and greater comorbidity burden were associated with higher mortality, with a stepwise gradient across aCCI categories (2-3, 4-5, and ≥6). Injury mechanism, upper-extremity fracture multiplicity, and treatment type were not significantly associated with 5-year mortality.

In older adults with major upper-extremity fractures, long-term mortality is substantial and is most strongly associated with baseline vulnerability-especially comorbidity burden-the presence of concomitant fractures outside the upper extremity, and fracture location. Larger multicenter studies incorporating standardized frailty and functional measures are needed to confirm these associations and to inform care pathways for high-risk patients.