Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schurch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 1996; 11: 1935–42.
Riggs BL, Melton LJ, 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995; 17: S505–11.
De Laet CE, Pols HA. Fractures in the elderly: epidemiology and demography. Baillières Best Pract Res Clin Endocrinol Metab 2000; 14: 171–9.
Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U.S. Medicare population. J Clin Epidemiol 1999; 52: 243–9.
Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 1996; 7: 612–8.
Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone 1996; 18: S209–13.
Kroner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. rch Orthop Trauma Surg 1989; 108: 288–90.
Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 1989; 108: 285–7.
Sarkar MR, Hoellen IP, Kinzl L. Fractures of the upper extremity in the elderly. Z Orthop Ihre Grenzgeb 1999; 137: 486–91.
Lee SH, Dargent-Molina P, Breart G. Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 2002; 17: 817–25.
Nguyen TV, Center JR, Sambrook PN, Eisman JA. Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Osteoporosis Epidemiology Study. Am J Epidemiol 2001; 153: 587–95.
Seeley D, Browner W, Nevitt M, Genant H, Scott J, Cummings S. Which fractures are associated with low appendicular bone mass in elderly women? Ann Intern Med 1991; 115: 837–42.
Lippuner K, von Overbeck J, Perrelet R, Bosshard H, Jaeger P. Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporos Int 1997; 7: 414–25.
Randell A, Sambrook PN, Nguyen TV, et al. Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporos Int 1995; 5: 427–32.
Nordell E, Jarnlo GB, Jetsen C, Nordstrom L, Thorngren KG. Accidental falls and related fractures in 65–74 year olds: a retrospective study of 332 patients. Acta Orthop Scand 2000; 71: 175–9.
Court-Brown CM, Garg A, McQueen MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. J Bone Joint Surg Br 2001; 83: 799–804.
Court-Brown CM, Cattermole H, McQueen MM. Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br 2002; 84: 504–8.
Ilchmann T, Ochsner PE, Wingstrand H, Jonsson K. Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures. A retrospective study of 34 fractures from two different trauma centers. Int Orthop 1998; 22: 316–20.
Zyto K, Ahrengart L, Sperber A, Tornkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 1997; 79: 412–7.
National Aging Information Center. Aging into the 21st century. 2001.
Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand 2000; 71: 465–70.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lübbeke, A., Stern, R., Grab, B. et al. Upper extremity fractures in the elderly: consequences on utilization of rehabilitation care. Aging Clin Exp Res 17, 276–280 (2005). https://doi.org/10.1007/BF03324610
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324610