Background Unstable intertrochanteric femur fractures are associated with increased morbidity and more complex surgical management than stable fractures. Although computed tomography (CT)-derived body composition parameters have been linked to frailty, mortality, and hip fracture risk, their association with fracture stability remains unclear. This study aimed to investigate the relationship between CT-derived psoas muscle measurements, trochanteric subcutaneous fat thickness, and fracture stability in older adults with intertrochanteric fractures. Methods This retrospective cohort study included 154 patients aged ≥65 years who underwent surgery for intertrochanteric femur fractures following low-energy same-level falls between January 2021 and January 2024. Fractures were classified as stable (31-A1) or unstable (31-A2/A3) according to the AO/OTA classification. Total psoas muscle cross-sectional area (CSA), psoas muscle attenuation, and trochanteric subcutaneous fat thickness were measured on preoperative CT images. Multivariate logistic regression was performed after adjustment for age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI). Results Seventy-five patients (48.7%) had stable fractures and 79 (51.3%) had unstable fractures. Compared with the stable group, patients with unstable fractures had significantly lower trochanteric subcutaneous fat thickness, total psoas CSA, and psoas muscle attenuation (all p < 0.001). In multivariate analysis, subcutaneous fat thickness (OR=0.888, 95% CI: 0.841–0.937; p< 0.001), total psoas CSA (OR=0.809, 95% CI: 0.701–0.932; p=0.003), and psoas muscle attenuation (OR=0.886, 95% CI: 0.816–0.962; p=0.004) were significantly associated with fracture instability. Age, sex, BMI, and CCI were not significantly associated with fracture instability. Conclusion Lower trochanteric subcutaneous fat thickness, reduced total psoas muscle CSA, and lower psoas muscle attenuation were associated with unstable intertrochanteric fracture patterns in older adults. These findings highlight the potential role of trochanteric subcutaneous fat thickness and psoas muscle characteristics in fracture instability.
Background Elderly distal humerus fractures can lead to substantial functional impairment. With a steadily aging population worldwide, understanding the outcomes of open reduction and internal fixation (ORIF) for distal humerus fractures in this group has become an important focus of orthopedic practice, and this study aims to identify factors affecting surgical outcomes in geriatric patients. Methods A total of 47 patients aged ≥65 years undergoing ORIF for distal humerus fractures between Jan 2023 and Jan 2025 with ≥12 months of follow-up were retrospectively reviewed, excluding non-operative treatment, arthroplasty, percutaneous pinning, external fixation, pathological or high-grade open fractures, and incomplete records. Demographic, clinical, laboratory, and fracture characteristics were systematically collected, and postoperative reduction quality was assessed. Intraoperative and postoperative complications, implant failure, fracture union, and revision surgery were recorded. Continuous variables were analyzed via t-tests or Mann–Whitney U tests, and categorical variables via Fisher’s exact test (p < 0.05). Results The mean age was 76 years, 80.9% were female, and the mean BMI was 27.9±3.2. The most frequent fracture patterns were AO/OTA A2 (36.2%) and C3 (23.4%), with triceps-sparing (68.1%) and olecranon osteotomy (25.5%) approaches and medial-posterolateral plating used in 78.7%. Good overall reduction was achieved in 55.3% and good capitellum reduction in 68.1%. Early complications included ulnar nerve palsy 14.9%, implant failure in 19.1%, nonunion in 21.3%, osteonecrosis in 6.4%, and revision surgery in 6.4%. Implant failure may be associated with younger age, lower BMI, higher postoperative extension limitation, and reoperation, while nonunion showed an association with lower BMI and poor reduction quality. Conclusion Double-plate ORIF provides adequate fixation and range of motion recovery in elderly distal humerus fractures, even in patients with poor bone quality. Patient-related factors, such as age and metabolic health, appear to be associated with implant failure and nonunion, emphasizing the necessity of comprehensive preoperative evaluation.
Background The choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) for intracapsular hip fracture remains debated. Randomised trials compare procedures in selected ambulant patients, but routine clinical practice is strongly influenced by baseline function, cognition and physiological reserve. We compared clinical outcomes and survival between THA and HA at a single UK major trauma centre, with pre-specified subgroup analysis by age ≤80 and ≥81 years. Methods Retrospective cohort study of 1,199 intracapsular hip fracture admissions (HA n=1,074; THA n=125) managed with arthroplasty at Lister Hospital between April 2020 and December 2024, using National Hip Fracture Database (NHFD) data. Continuous variables were compared by Mann-Whitney U test; categorical variables by Fisher’s. Survival was analysed by Kaplan-Meier with log-rank testing (IBM SPSS v22.0). Results Across the whole cohort (THA n=125, HA n=1,074) THA patients were on average 12 years younger (72.58 vs 84.38 years), had lower mean ASA grades (2.33 vs 3.03), were almost exclusively living at home before their fracture (99.2% vs 82.4%), and were predominantly freely mobile before their fracture (85.6% vs 35.7%). In the ≤80 group (THA n=110, HA n=286), THA was associated with shorter length of stay (median 7 vs 11 days; p<0.001), a higher rate of return to home from home (94.5% vs 78.0%), better post-fracture mobility, and superior survival (mean 359.6 vs 319.8 days; p<0.001). THA patients entered surgery with near ceiling AMTS scores (mean 9.86) and near zero post operative 4AT scores (mean 0.16), whereas HA patients had lower pre operative AMTS scores (mean 7.40) and higher post operative 4AT (mean 1.82). In the ≥81 group (THA n=15, HA n=788), no significant differences were found in survival (p=0.207), length of stay (p=0.663), discharge destination or time to surgery (p=0.077). Re-operations were more frequent in THA (13.3% vs 0.6%; p=0.007), based on two events in 15 patients. Conclusions THA patients had better unadjusted outcomes in the ≤80 group, but adjusted analyses suggest these differences were largely explained by baseline selection factors rather than procedure type alone. In patients ≥81 years, the THA sample was too small for firm conclusions.
Background Proximal humerus fractures in older adults are increasingly recognized as fragility injuries associated with substantial morbidity and mortality. However, factors independently associated with mortality in elderly patients with proximal humerus fractures remain incompletely understood. Methods This retrospective single-center cohort study included consecutive patients aged ≥65 years treated for proximal humerus fractures between February 2017 and June 2024. Demographic characteristics, treatment-related variables, comorbidity burden, and laboratory findings were collected from institutional records. Mortality data were obtained from the national civil registration system. Survival time was defined from the date of injury to death or final mortality status assessment. Univariable analyses and multivariable Cox proportional hazards regression were performed to identify independent predictors of mortality. Results A total of 261 patients were included, of whom 34 (13.0%) died during follow-up. Non-survivors were significantly older and demonstrated higher Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists scores, longer hospital stays, and lower rates of surgical treatment. Laboratory analyses showed significantly lower hemoglobin, hematocrit, platelet count, lymphocyte count, and albumin levels, and higher urea and creatinine levels among non-survivors. In multivariable Cox regression, higher CCI was independently associated with increased mortality (HR: 1.47, 95% CI: 1.25–1.73; p<0.001), whereas higher albumin (HR: 0.26, 95% CI: 0.15–0.45; p<0.001) and platelet count (HR: 0.91, 95% CI: 0.86–0.96; p=0.001) were associated with lower mortality risk. Conclusions Mortality after proximal humerus fractures in elderly patients appears to be associated with comorbidity burden and markers of systemic physiological vulnerability. Higher CCI, lower serum albumin, and lower platelet count were independently associated with mortality. These routinely available clinical and laboratory parameters may assist in early risk stratification and identification of high-risk individuals in clinical practice.
Background The transition into an informal caregiving role following a family member’s hip fracture is a significant life event that may adversely affect the caregiver’s Quality of Life (QoL). While global caregiver burden is a known concern, research often treats it as a monolithic construct. This study aimed to examine the multidimensional nature of caregiver burden and its association with QoL to identify significant independent predictors of QoL impairment among hip fracture caregivers. Methods A descriptive-analytical cross-sectional study was conducted at a major orthopedic trauma referral center in Tehran, Iran. The sample included 149 primary, unpaid family caregivers of patients 1 to 3 months post-hospital discharge. Caregiver burden was assessed using the 24-item Caregiver Burden Inventory (CBI), covering five dimensions: time-dependence, developmental, physical, social, and emotional burden. QoL was measured using the 36-Item Short Form Survey (SF-36). Data were analyzed using hierarchical multiple linear regression to isolate independent predictors while controlling for sociodemographic and clinical covariates. Results The sample (n = 149; 52.3% female; mean age = 41.32 ± 11.82 years) exhibited a strong inverse correlation between total caregiver burden and overall QoL (r=−0.549, p<0.01). The final hierarchical regression model explained 35.2% of the variance in QoL (Adjusted R 2 = 0.305, p<0.001). After adjusting for covariates, time-dependent burden (β=−.309, p=0.001), physical burden (β=−.238, p=0.015), and social burden (β=−.198, p=0.039) emerged as significant independent predictors of lower QoL. Notably, the developmental and emotional dimensions of burden were not statistically significant predictors in the fully adjusted model. Conclusion Findings suggest that time-dependent, physical, and social stressors are significant correlates of QoL impairment in this single-center sample of relatively high-functioning caregivers; generalizability to broader caregiver populations requires confirmation. Rather than isolating psychological distress, clinical support strategies should prioritize an integrated approach, complementing traditional counseling with practical interventions such as ergonomic patient-handling training and respite services.
