Combined proximal humerus fractures are associated with greater mortality and morbidity compared with isolated fractures: a retrospective cohort study.

Abstract

Proximal humerus fractures (PHFs) are the third most common type of osteoporotic fracture. One-year mortality rates following PHF are between 4% and 15%. This study examines whether combined fractures involving PHFs and other osteoporotic fractures increase mortality and morbidity rates compared with isolated PHFs. This is a retrospective study on patients aged ≥45 years with PHF between January 1, 2011, and December 31, 2020, in Israel's largest health maintenance organization. Fractures were categorized as isolated PHFs or combined fractures involving the proximal humerus with a femoral, distal radial, or vertebral fracture. Patient characteristics, mortality, and morbidity were recorded. Kaplan-Meier survival curves and Cox regression models were used to assess mortality and morbidity. This study included 21,647 patients, 713 in the combined fracture group and 20,934 in the isolated PHF group. The combined fracture group had significantly higher 1-year mortality (14.7% vs. 5.7%, P < .001). After adjusting for covariates, combined fractures involving the femur (hazard ratio [HR] = 1.885, P = .003) or vertebra (HR = 1.751, P = .020) were associated with higher mortality, whereas combined fractures with the radius were not. Morbidity was higher in the combined fracture group, with increased rates of pulmonary embolism (HR = 2.740, P = .012), deep vein thrombosis (HR = 4.982, P = .021), and sepsis (HR = 2.132, P = .018). This study showed that combined fractures with femoral or vertebral fractures are associated with significantly higher mortality and morbidity compared with isolated PHFs.