Functional Trajectories Following Clinically Selected Management of Concomitant Proximal Humerus Fractures in Geriatric Hip-Fracture Patients: A Retrospective Cohort Study

Abstract

Background/Objectives: Concomitant hip and proximal humerus fractures create a demanding rehabilitation scenario in older adults. We described unadjusted functional trajectories following clinically selected proximal humerus management and explored the relationship between baseline independence and treatment allocation. Methods: We retrospectively reviewed 4776 hip-fracture presentations (2011–2023); 55 patients aged > 65 years had synchronous proximal humerus fractures. All hip fractures were surgically treated; 13 proximal humerus fractures were managed operatively and 42 non-operatively. Barthel Index was assessed before fracture, at 30 days, and at six months. Results: Mean pre-fracture Barthel scores were 98.5 ± 3.8 and 79.5 ± 20.8 in the operative and non-operative groups, respectively. At 30 days, scores were 85.4 ± 6.9 versus 60.5 ± 23.9; at six months, scores were 93.5 ± 5.2 versus 70.2 ± 25.0. Mean absolute change from baseline at six months was −5.0 versus −9.3 points. Conclusions: Patients selected for surgery were more independent before injury and remained more independent at follow-up. Marked pre-injury differences and confounding by indication prevent any inference about the independent effect of proximal humerus surgery.