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Background and aims: While hip fractures represent the most dramatic consequence of osteoporosis, fractures of the humerus, forearm and wrist account for one-third of the total incidence of fractures due to osteoporosis in the older population. The aim of this retrospective cohort study was to evaluate rehabilitation care utilization and associated factors in elderly individuals with upper limb fracture. Methods: Over two years, 667 patients 65 years of age or older were studied, who presented to the emergency department either from their private homes or nursing homes with an upper extremity fracture. The following outcome variables were collected: gender; age; residence; location of fracture; treatment; discharge destination; length of hospitalization; length of stay in a rehabilitation facility; and ultimate place of habitation after the event. Results: The most frequent sites of fracture were distal radius (37.2%) and proximal humerus (29.1%). Two-thirds of the patients were treated non-operatively. Inpatient rehabilitation care was necessary for 248 patients (37.2%; length of stay, 46 days). Factors associated with increased care included older age (≥80 years), coming from private home, sustaining two fractures, fractures of the humerus, and operative treatment. Six percent of the patients required permanent nursing home care. Conclusions: Upper extremity fractures in older people often require prolonged hospitalization and therefore account for considerable health care costs. Reasons are more related to advanced age and living conditions than to particular injury or treatment

Background and aims: Many studies have identified specific demographic, social, health or life-style pre-operative indicators of long-term outcome among older hip fracture patients who underwent surgical treatment. The purpose of this study was to determine the predictive value of peri- and intra-operative factors, and more specifically of the pre-operative American Society of Anesthesiologists (ASA) score on functional outcome in these patients. Methods: A questionnaire designed to assess pre-fracture functional and health status was administered to surgically treated hip fracture patients. Post-fracture functional and health status was further ascertained by in-home interview one year after the operation. Among 140 consecutive eligible patients older than 65 years, 10 either refused subsequent interviews or could not be contacted; an additional 16 patients died during the year of follow-up, leaving 114 patients available for this study. Results: The average age of the patients was 82.4 years. Almost two-thirds of them suffered from severe systemic disease, whether or not incapacitating (ASA grades III-IV). Subjects classified in these categories presented more frequently with cardiovascular disorders, were more frequently disoriented, and already had some pre-fracture difficulty with ambulation. The mortality at one year was almost nine times higher in severely impaired patients (grades III-IV) than in healthy or mildly affected patients (grades I-II). Functional outcome and/or ambulatory ability assessed at one year did not reveal any statistically significant difference between the ASA I-II and III-IV groups. The most pronounced difference was noticed for the functional independence measured by the ADL score (p=0.236). Better prognoses were consistently recorded for patients with an intracapsular fracture, for those who were operated within 24 hours, for those treated with a prosthesis as opposed to internal fixation, and for those whose operating time was less

Background. Many investigators have identified distinct medical, demographic and psychosocial prefracture conditions that influence the functional outcome of patients surgically treated for a fracture of the hip. However, to design efficient intervention care programs addressing the needs of these patients, at optimal economic and social costs, more information is required on the typical combinations of prognostic determinants actually encountered. Methods. Data on specific descriptors of the prefracture status and on mobility and functioning 1 year after surgical intervention were collected by interview from 253 consecutive patients hospitalized for a fracture of the proximal femur. Cluster analysis was used to form homogeneous groups of patients with similar profiles in terms of the 13 predictive variables and the 7 outcome variables significantly interrelated. The modeling procedure generated four clusters of patients with a typical profile sharply contrasted by their structure. Results. Subjects of two clusters could walk without difficulty and were functionally independent prior to their hip fracture. One year later, however, mobility and functioning were only fully recovered by the members of one cluster. The majority of predictors were of less favorable prognostic value for the members of the second cluster. The other two clusters regrouped patients with impaired prefracture mobility that were either unaltered or even aggravated 1 year later. Conclusions. Cluster analysis identified typical profiles of elderly hip fracture patients. Close scrutiny of their respective global structure, in terms of combined prognostic determinants and outcomes, may help to develop specific management strategies that are more efficiently adapted to these different groups of patients

Background and aims: Many studies have identified specific demographic, social, health or life-style pre-operative indicators of long-term outcome among older hip fracture patients who underwent surgical treatment. The purpose of this study was to determine the predictive value of peri- and intra-operative factors, and more specifically of the pre-operative American Society of Anesthesiologists (ASA) score on functional outcome in these patients. Methods: A questionnaire designed to assess pre-fracture functional and health status was administered to surgically treated hip fracture patients. Post-fracture functional and health status was further ascertained by in-home interview one year after the operation. Among 140 consecutive eligible patients older than 65 years, 10 either refused subsequent interviews or could not be contacted; an additional 16 patients died during the year of follow-up, leaving 114 patients available for this study. Results: The average age of the patients was 82.4 years. Almost two-thirds of them suffered from severe systemic disease, whether or not incapacitating (ASA grades III-IV). Subjects classified in these categories presented more frequently with cardiovascular disorders, were more frequently disoriented, and already had some pre-fracture difficulty with ambulation. The mortality at one year was almost nine times higher in severely impaired patients (grades III-IV) than in healthy or mildly affected patients (grades I-II). Functional outcome and/or ambulatory ability assessed at one year did not reveal any statistically significant difference between the ASA I-II and III-IV groups. The most pronounced difference was noticed for the functional independence measured by the ADL score (p=0.236). Better prognoses were consistently recorded for patients with an intracapsular fracture, for those who were operated within 24 hours, for those treated with a prosthesis as opposed to internal fixation, and for those whose operating time was less

Background. Many investigators have identified distinct medical, demographic and psychosocial prefracture conditions that influence the functional outcome of patients surgically treated for a fracture of the hip. However, to design efficient intervention care programs addressing the needs of these patients, at optimal economic and social costs, more information is required on the typical combinations of prognostic determinants actually encountered. Methods. Data on specific descriptors of the prefracture status and on mobility and functioning 1 year after surgical intervention were collected by interview from 253 consecutive patients hospitalized for a fracture of the proximal femur. Cluster analysis was used to form homogeneous groups of patients with similar profiles in terms of the 13 predictive variables and the 7 outcome variables significantly interrelated. The modeling procedure generated four clusters of patients with a typical profile sharply contrasted by their structure. Results. Subjects of two clusters could walk without difficulty and were functionally independent prior to their hip fracture. One year later, however, mobility and functioning were only fully recovered by the members of one cluster. The majority of predictors were of less favorable prognostic value for the members of the second cluster. The other two clusters regrouped patients with impaired prefracture mobility that were either unaltered or even aggravated 1 year later. Conclusions. Cluster analysis identified typical profiles of elderly hip fracture patients. Close scrutiny of their respective global structure, in terms of combined prognostic determinants and outcomes, may help to develop specific management strategies that are more efficiently adapted to these different groups of patients

Background and aims: While hip fractures represent the most dramatic consequence of osteoporosis, fractures of the humerus, forearm and wrist account for one-third of the total incidence of fractures due to osteoporosis in the older population. The aim of this retrospective cohort study was to evaluate rehabilitation care utilization and associated factors in elderly individuals with upper limb fracture. Methods: Over two years, 667 patients 65 years of age or older were studied, who presented to the emergency department either from their private homes or nursing homes with an upper extremity fracture. The following outcome variables were collected: gender; age; residence; location of fracture; treatment; discharge destination; length of hospitalization; length of stay in a rehabilitation facility; and ultimate place of habitation after the event. Results: The most frequent sites of fracture were distal radius (37.2%) and proximal humerus (29.1%). Two-thirds of the patients were treated non-operatively. Inpatient rehabilitation care was necessary for 248 patients (37.2%; length of stay, 46 days). Factors associated with increased care included older age (≥80 years), coming from private home, sustaining two fractures, fractures of the humerus, and operative treatment. Six percent of the patients required permanent nursing home care. Conclusions: Upper extremity fractures in older people often require prolonged hospitalization and therefore account for considerable health care costs. Reasons are more related to advanced age and living conditions than to particular injury or treatment