Gender-Based Frailty in Multiple Orthopedic Fractures.

The 5-factor modified frailty index (mFI-5) has been used as a prognostic tool to identify patients at higher risk for complications and mortality but has not been used to assess the relationship between frailty and extent of injury following ground-level falls. The aim of this study was to determine if mFI-5 is associated with increased risk for combined femur-humerus fractures compared to isolated femur fractures in geriatric patients. A retrospective analysis of 2017-2018 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) data identified 190 836 patients with femur fractures and 5054 patients with combined femur-humerus fractures. In multivariate analysis, gender was the only statistically significant predictor for risk of combined vs isolated fractures (OR 1.69, 95% CI [1.65, 1.74], P < .001). While outcome data for the mFI-5 repeatedly shows increased risk for adverse events, this tool may over-estimate the disease specific risk factors rather than the overall frailty state of the patient and diminish its predictive power.

Combined Upper-Lower Extremities Fractures in the Elderly.

Age-related bone loss is believed to increase the risk of traumatic fragility fractures in both men and women. We aimed to determine the risk factors associated with simultaneous fractures in the upper-lower extremities. This retrospective study utilized the ACS-TQIP database from 2017 to 2019 to identify patients with respective fractures caused by ground-level falls. A total of 403,263 patients with femur fractures and 7,575 patients with combined upper-lower extremities (humerus-femur) fractures were identified. Patients had higher odds of combined upper-lower extremities fractures with increasing age: 18-64 (OR 1.05, P < .001); 65-74 (OR 1.72, P < .001); and 75-89 (OR 1.90, P < .001) while adjusting for other statistically significant risk factors. Advanced age increases the risk of traumatic combined upper-lower extremities fractures. Prevention strategies should be emphasized to reduce the burden of simultaneous injury in the upper-lower extremities.