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Aims: To present a large series of concurrent upper limb and hip fracture in the elderly treated at a United Kingdom major trauma centre., Patients and Methods: Prospective data collection was performed for all elderly patients admitted to a single centre with hip fracture between January 2006 and November 2015. Comparative analysis of concurrent upper limb and hip fracture and an isolated hip fracture was performed., Results: Study cohort included 307 patients that had sustained concurrent upper limb and hip fracture and 6887 with an isolated hip fracture. A concurrent upper limb fracture was associated with increased length of stay (21.7 vs. 18.8 days, p = 0.003) and decreased proportion of patients returning to their own home at discharge (39.2% vs. 49.4%, p = 0.001). No differences in age, Abbreviated Mental Test (AMT), Nottingham Hip Fracture Score (NHFS) and mortality were identified. However, concurrent wrist fracture 365-day mortality was lower than that of isolated hip fracture (20.9% vs 29.2%, p = 0.018). Concurrent humerus fracture was associated with increased inpatient death (13.7% vs 6.4%, p = 0.046) and 365-day mortality (34.7% vs 20.9%, p = 0.014) compared to concurrent wrist fracture. Surgical stabilisation of the concurrent upper limb fracture was performed in 90 wrist (52.3%) and 13 humerus (13.7%) cases. Operative management of the concurrent fracture did not yield significant differences in acute hospital length of stay or rehabilitation requirement. Cox regression analysis of 365-day survival data demonstrated that age, NHFS, AMT, gender and presence of a concurrent upper limb fracture independently influence 365-day mortality rate., Conclusion: There are increased rehabilitation requirements for elderly patients with concurrent upper limb and hip fractures. There is a marked distinction in survivorship outcomes for patients sustaining concurrent wrist and concurrent humerus fractures., Clinical Relevance: Demonstrates increased rehabilitation requirements in concurrent upper limb and hip fracture in the elderly Highlights concurrent humerus fracture as a high risk group., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Ltd.)

Introduction: This study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures., Patients and Methods: Patients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005-2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex., Results: Plate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/-62 min vs. 102 +/-54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26-7.85)., Conclusion: Patients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Aim: To test a mathematical program to monitor early haemodynamic patterns of patients with fractures, predict survival and support initial therapeutic decisions., Methods: A mathematical search and display program based on non-invasive haemodynamic monitoring was used to study 430 consecutively monitored patients with fractures during the first 48 h after admission to the emergency department of an inner city public hospital. We studied four types of fractures: simple extremity fractures, long-bone fractures, pelvic fractures and fractures incidental to severe trauma. The program continuously displayed haemodynamic patterns and predicted survival probability (SP), which was evaluated by the actual outcome at hospital discharge. The program also assessed the effectiveness of therapies according to haemodynamic responses., Results: The cardiac index, heart rate, mean arterial pressure, arterial saturation and transcutaneous oxygen tensions at the initial resuscitation were significantly higher in survivors than in non-survivors. After the first 48 h, the haemodynamic patterns were more influenced by fever, sepsis, complications and organ failures. The calculated survival probability averaged 81%+/-18% in the first 48 h for survivors and 72%+/-20% for non-survivors., Conclusion: Early continuous non-invasive haemodynamic monitoring using the proposed information system is helpful in predicting outcome and guiding therapy for patients with fractures.