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Aims: This study aimed to show the mortality rate following humeral shaft fragility fractures (HSFF) in the elderly. The secondary aim was to examine the predictors associated with mortality in elderly patients who have sustained HSFF., Methods: From 2011 to 2020, all elderly patients aged 65 years and older with HSFF managed at our nine hospitals were retrospectively identified from our TRON database. Patient demographics and surgical characteristics were extracted from medical records and radiographs, and multivariable Cox regression analysis was used to identify factors affecting mortality., Results: In total, 153 patients who sustained HSFF were included. The mortality rate for HSFF in the elderly was 15.7% at 1 year and 24.6% at 2 years. Multivariable Cox regression analysis showed significant differences in survival for the following variables: older age (p < 0.001), underweight (p = 0.022), severely ill (p = 0.025), mobility limited to indoors (p = 0.003), dominant-side injury (p = 0.027), and nonoperative treatment (p = 0.013)., Conclusion: The outcome following HSFF in the elderly population appears to be relatively grim. The prognosis of elderly patients with HSFF is closely related to their medical history. In the elderly patients with HSFF, operative treatment should be positively considered while taking into account their medical status., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Research regarding the epidemiology of paediatric trauma is limited. Using our unique classification, we describe paediatric trauma cases in a 10-year single-centre study to improve paediatric care., Materials and Methods: Data regarding all paediatric trauma cases were extracted using a computerised medical record system that detected fracture diagnosis and epiphyseal injury. Registry search identified cases from January 2008 to December 2017. Age, sex, type of fracture, and details of injury mechanism were analysed, and we categorised the 'falls/turnover' mechanism using a new trauma energy classification based on speed and height., Results: A total of 1379 cases (953 boys and 426 girls) were included. The highest number of injuries (553 cases, 40%) was seen in school children (aged 6 to 10 years). Forearm fracture occurred most frequently, followed by humeral fracture. The most frequent injury mechanism in falls/turnover (969 cases, 70%) was sports in 272 cases (28%), playground equipment in 179 cases (18%), furniture in 102 cases (11%), and bicycling in 87 cases (9%). We classified 956 cases of falls/turnover using our trauma energy classification scheme. Most cases (29%) were classified into the L2 category (low height and high speed), followed by the L1 category (low height and low speed) (p < 0.01). Subcategory analysis using the classification revealed that younger children were more likely to be injured by falling from high places because of their physique, whereas older children were more likely to be injured by a turnover from lower places and at higher speed., Conclusion: We describe the epidemiology of fractures in detail and present a new classification system, which may aid in understanding the injury mechanism independent of children's height. The fact that paediatric fractures occur at relatively low energy levels and are trended by age, activity, and sex, could be of potential universal use for their prevention and parent education., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Ltd.)

Aims: To present a large series of concurrent upper limb and hip fracture in the elderly treated at a United Kingdom major trauma centre., Patients and Methods: Prospective data collection was performed for all elderly patients admitted to a single centre with hip fracture between January 2006 and November 2015. Comparative analysis of concurrent upper limb and hip fracture and an isolated hip fracture was performed., Results: Study cohort included 307 patients that had sustained concurrent upper limb and hip fracture and 6887 with an isolated hip fracture. A concurrent upper limb fracture was associated with increased length of stay (21.7 vs. 18.8 days, p = 0.003) and decreased proportion of patients returning to their own home at discharge (39.2% vs. 49.4%, p = 0.001). No differences in age, Abbreviated Mental Test (AMT), Nottingham Hip Fracture Score (NHFS) and mortality were identified. However, concurrent wrist fracture 365-day mortality was lower than that of isolated hip fracture (20.9% vs 29.2%, p = 0.018). Concurrent humerus fracture was associated with increased inpatient death (13.7% vs 6.4%, p = 0.046) and 365-day mortality (34.7% vs 20.9%, p = 0.014) compared to concurrent wrist fracture. Surgical stabilisation of the concurrent upper limb fracture was performed in 90 wrist (52.3%) and 13 humerus (13.7%) cases. Operative management of the concurrent fracture did not yield significant differences in acute hospital length of stay or rehabilitation requirement. Cox regression analysis of 365-day survival data demonstrated that age, NHFS, AMT, gender and presence of a concurrent upper limb fracture independently influence 365-day mortality rate., Conclusion: There are increased rehabilitation requirements for elderly patients with concurrent upper limb and hip fractures. There is a marked distinction in survivorship outcomes for patients sustaining concurrent wrist and concurrent humerus fractures., Clinical Relevance: Demonstrates increased rehabilitation requirements in concurrent upper limb and hip fracture in the elderly Highlights concurrent humerus fracture as a high risk group., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Hip fracture and upper extremity fracture are most important age-related fracture. However, there have been few reports about the analysis of prevalence or risk factors with concomitant hip and upper extremity fractures. This study aimed to describe the prevalence and clinical implications of the concomitant hip and upper extremity fractures in elderly., Methods: We evaluate 1018 patients aged >65 years who were surgically treated for femoral neck or intertrochanteric fractures between March 2008 and December 2018. 35 patients (3.4%) with a hip fracture combined upper extremity fracture. All patients were classified into the isolated hip fracture and the concomitant fracture. We analyzed these patients' characteristics such as age, gender, bone mineral density (BMD), body mass index (BMI), Korean version of Mini-Mental State Examination (MMSE-K), injury mechanism, and length of hospital stay., Results: The most common site of upper extremity fracture was distal radius fracture of 15 patients (42.8%), followed by proximal humeral fracture of 8 (22.8%). Concomitant fractures occurred on the same side in 30 patients (85.7%). The mean age of patients with a concomitant fracture was younger than that of patients with an isolated hip fracture (p < 0.05). Mean preinjury MMSE-K was 22.7 in isolated hip fracture and 25.6 in concomitant fracture patients (p < 0.05). Mean length of hospital stay was statistically significant different between two groups (p < 0.05). According to fracture site of hip, there was no statistically different prevalence of upper extremity fracture in femoral intertrochanteric fracture compared to the neck fracture., Conclusion: We found a 3.4% prevalence of concomitant hip and upper extremity fractures. It was found that the younger the age with preserved cognitive ability in elderly patients with a hip fracture, the higher the prevalence of upper extremity fracture. In addition, it is important to keep in mind that patients with a concomitant fracture have a longer hospital stay and difficulty in rehabilitation., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Obesity was associated with poor treatment outcome in paediatric supracondylar humeral fractures. It is controversial about the association is related to more severe fractures in obese children or obesity directly affects treatment. The purpose of this study was to evaluate the influence of obesity on surgical outcomes after control of fracture severity., Patients and Methods: This is a retrospective comparative study of 107 children treated for type III supracondylar humeral fractures between January 2009 and December 2013. Children were classified according to sex-specific body mass index (BMI)-for-age growth chart into 4 groups: underweight group (n=10); normal-weight group (n=71); overweight group (n=13); and obese group (n=13). Clinical outcomes were assessed using the Flynn criteria. Radiographic evaluation included the Baumann angle and the lateral humerocapitellar angle. Loss of reduction was defined by Skaggs' criteria., Results: The mean age, sex, and Flynn criteria were comparable among the four BMI groups. Obese children were more likely to develop a varus change in the Baumann angle (p=0.017) and loss of reduction in varus (p=0.059) postoperatively. The risk for pin-related complications was significantly higher in overweight and obese children (p=0.013)., Conclusions: Obesity was associated with more postoperative varus deformation and pin-related complications after surgical fixation for type III supracondylar fracture. These findings underline the importance of stable fixation and close post-operative monitoring in obese children., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: This study aimed to examine long-term population-based trends in the incidence rate of patients with a humeral fracture admitted to a hospital in the Netherlands from 1986 to 2012 and to give a detailed overview of the health care consumption and productivity loss with associated costs., Materials and Methods: Age and gender-standardised incidence rates of hospital admissions for patients with a proximal, shaft, or distal humeral fracture were calculated for each year (1986-2012). Injury cases, length of hospital stay (LOS), trauma mechanism, and operation rate were extracted from the National Medical Registration. An incidence-based cost model was applied to calculate costs for direct health care and lost productivity in 2012., Results: Between 1986 and 2012 112,910 patients were admitted for a humeral fracture. The incidence rate increased from 17.8 in 1986 to 40.0 per 100,000 person years in 2012. Incidence rates of proximal fractures increased the most, especially in elderly women. Operation rates decreased in patients aged 70 years or older. The mean LOS decreased from nine days in 1997 to five days in 2012. The cumulative LOS of all patients in 2012 was 28,880 days of which 73% were caused by women and 81% were caused by patients aged 50 years or older. Cumulative medical costs in 2012 were M€55.4, of which M€43.4 was spent on women. Costs increased with age. Costs for hospital care contributed most to the overall costs per case until 70 years of age. From 70 years onwards, the main cost determinants were hospital care, rehabilitation/nursing care, and home care. Cumulative costs due to lost productivity were M€23.5 in 2012. Costs per case increased with age in all anatomic regions., Conclusions: The crude number of patients admitted for a humeral fracture increased 124% in 27 years, and was associated with age and gender. Proximal fractures in elderly women accounted most significantly for this increase and most of the costs. The main cost determinants were hospital care and productivity loss., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Supracondylar humerus fractures (SCHF) are the most common elbow fractures requiring surgical treatment in the pediatric age group. Most fractures are reduced and stabilised adequately. Yet, post-surgical malunion may occur. The purpose of this study is to evaluate our results of early revision surgery in 21 surgically treated pediatric SCHF with immediate postoperative loss of alignment and compare them with previous reports of late corrective osteotomies., Methods: Twenty-one pediatric SCHF patients that underwent revision surgery for malalignment within 3 weeks of the initial reduction and fixation consisted the study group. Indications for revision were unacceptable radiographic alignment diagnosed within the first 3 weeks after the index surgery. Clinical outcome included pain, range of motion (ROM) and appearance of the elbow. Radiographic outcome was defined as fracture healing and final alignment, assessed in both coronal and sagittal planes., Results: The average time interval between index and revision surgery was 7.6 days (range 3-18). In revision surgery, closed reduction was performed in 17 out of 21 patients, and open reduction was required in four. In one patient, an external fixator was added. In the most recent follow up, all patients but three regained full ROM. The remaining three had a deficit of 10° or less. Two patients had cubitus varus of 10° or less. All patients had a marked radiographic improvement after revision, especially in the sagittal plane increasing the humero-capitaller flexion angle by an average of 20°., Discussion: Malunion after reduction and Kirschner wires (KW) fixation of SCHF is an uncommonly reported phenomenon. When malunion is recognised after fracture healing, corrective osteotomies may carry a significant complications rate. We describe our favourable experience with early diagnosis and revision surgery of malaligned SCHF., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to determine patient variables that are independent predictors of validated functional outcome scores after humeral diaphyseal fractures., Methods: Adult patients with humeral shaft fractures were retrospectively recruited from a level 1 trauma centre over an 8-year period. Basic demographic information was obtained along with Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test (SST) and Short Form 12 (SF-12) physical component summary (PCS) and mental component summary (MCS). Regression analysis was performed to identify patient factors associated with satisfactory outcomes, defined as DASH<21; SST≥10; PCS≥40; and MCS≥40. Of 95 eligible patients, 77 were recruited. Participants had an average age of 47±20 years. Forty-five patients were treated with surgery and 32 healed non-operatively. The average follow-up was 48±29 months., Results: Satisfactory DASH scores decreased with increase in age (odds ratio (OR) 0.95; P=0.023). Satisfactory SST scores were more likely in patients without a history of psychiatric illness (OR 6.3; P=0.01). Satisfactory SF-12 PCS scores were more likely with no psychiatric history (OR 12; P=0.007) and in patients with private insurance (OR 11.4; P=0.03), but these scores decreased with rising Charlson comorbidity index (CCI; OR 0.50; P=0.023). Satisfactory SF-12 MCS scores increased in the absence of psychiatric history (OR 39; P=0.003), and decreased with rising CCI score (OR 0.54; P=0.035). Analysis of patients younger than 50 years of age (n=38) revealed that the absence of psychiatric history increased the odds of satisfactory DASH scores (OR 10.4; P=0.04). Patients aged ≥50 (n=39) had worse DASH scores with increasing age (OR 0.89; P=0.037), better SST scores with middle-third fractures compared to proximal (OR 7.8; P=0.039), better SF-12 PCS with no psychiatric history (OR 16.1; P=0.018) and worse scores with rising CCI (OR 0.50; P=0.036), while rising CCI decreased the odds of satisfactory SF-12 MCS scores (OR 0.47; P=0.046). Treatment modality, associated fractures and classification as "high energy" mechanism were not associated with outcome., Conclusion: Patient age, history of psychiatric illness, insurance type, fracture location and Charlson comorbidity index scores had a statistically significant effect on patient-reported functional outcomes following treatment of humeral shaft fractures, regardless of treatment modality, injury mechanism and associated fractures. The impact of these variables may be age dependent., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: The epidemiology of paediatric supracondylar fracture (SCF) fixation has not been evaluated at a population level. The purpose of this study was to: (1) determine the incidence density rate (IDR) of SCF fixation and (2) determine the rate of and risk factors for re-operation., Methods: Using administrative databases, all patients who underwent SCF fixation (closed reduction percutaneous pinning (CRPP) or open reduction (OR)) in Ontario between April 2002 and March 2010 were identified. Exclusion criteria included age (>12 years), a prior or concurrent non-SCF elbow fracture or previous humeral osteotomy. The overall IDR of SCF fixation and for subgroups of age, sex and season were calculated. A multivariate regression (immediate and short-term re-operation) and a Cox proportional hazards model (long-term re-operation) were used to identify patient, injury and provider factors that influenced re-operation risk and were reported as odds ratios or hazard ratios (HRs) with 95% confidence intervals (CIs), respectively., Results: A total of 3235 patients with a median age of 6.0 years (interquartile range (IQR): 3.0) underwent SCF fixation. The median follow-up was 6.0 years (IQR: 3.7). The majority underwent a CRPP (78.7%) which were performed after hours (75.6%). The overall IDR was 20.7/100,000 person-years (py), but it varied significantly by season and age. Re-operation was uncommon in the immediate (1.0%), short-term (1.4%) and long-term (0.3%) follow-up period. As compared to CRPP, patients who underwent OR were more likely to undergo early nerve exploration (odds ratio: 7.8 (CI: 3.0-20.6)) and re-operation in the long term (HR: 3.0 (CI: 1.0-8.7)). Increased surgeon volume of SCF fixation was protective against repeat fixation (odds ratio: 0.9 (CI: 0.9-1.0)) and re-operation in the long term (HR: 0.9 (CI: 0.8-1.0))., Conclusions: While SCF fixation is common, the rate of re-operation is low. No differences existed between the sexes and a higher volume of fixations occurred during the summer months., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Humeral shaft fractures account for 1-3% of all fractures and 20% of the fractures involving the humerus. The aim of the current study was to compare the outcome after operative and non-operative treatment of humeral shaft fractures, by comparing the time to radiological union and the rates of delayed union and complications., Methods: All patients aged 16 years or over treated for a humeral shaft fracture during a 5-year period were included in this retrospective analysis; periprosthetic and pathological fractures were excluded. Radiographs and medical charts were retrieved and reviewed in order to collect data on fracture classification, time to radiographic consolidation and the occurrence of adverse events., Results: A total of 186 patients were included; 91 were treated non-operatively and 95 were treated operatively. Mean age was 58.7 ± 1.5 years and 57.0% were female. In 83.3% of the patients, only the humerus was affected. A fall from standing height was the most common cause of the fracture (72.0%). Consolidation time varied from a median of 11-28 weeks. The rate of radial nerve palsy in both groups was similar: 8.8% versus 9.5%. In 5.3% of the operatively treated patients, the palsy resulted from the operation. Likewise, delayed union rates were similar in both groups: 18.7% following non-operative treatment versus 18.9% following surgery., Conclusion: The data indicated that consolidation time and complication rates were similar after operative and non-operative treatment. A prospective randomised clinical trial comparing non-operative with operative treatment is needed in order to examine other aspects of outcome, meaning shoulder and elbow function, postoperative infection rates, trauma-related quality of life and patient satisfaction., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Humeral-shaft fractures are not uncommon osteoporotic fractures. While most of the humeral-shaft fractures can be treated conservatively, some need surgical treatment. The purpose of this study was to assess the trends of the surgical treatment of humeral-shaft fractures. The study determined whether surgical treatment of humeral-shaft fractures has changed in Finland between 1987 and 2009. We assessed the number and incidence of surgically treated humeral-shaft fractures in each year and recorded the type of surgery used., Patients and Methods: The study covered the entire adult (>18 years) population in Finland over the 23-year period from 1 January 1987 to 31 December 2009. Data on surgically treated humeral-shaft fractures were obtained from the nationwide National Hospital Discharge Registry., Results: During the 23-year study period, a total of 4469 surgical operations of the humeral shaft were performed in Finland. The male patients were markedly younger (49 years) than their female counterparts (63 years). The incidence of surgical treatment nearly doubled in men and over tripled in women. Between 1987 and 2009, there occurred a clear shift towards plating in the surgical treatment of humeral-shaft fractures., Conclusions: A marked increase in the surgical treatment of humeral-shaft fractures was seen in Finland in 1987-2009. Fracture plating increased during the first decade of the millennium. Since high-quality evidence for treatment of humeral-shaft fractures is absent, critical evaluation of the chosen treatment options is needed., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: The incidence of children's forearm fractures is increasing worldwide. This is different from the declining trend observed in the overall injury rate, and the reason for the increase is not known. Diaphyseal forearm fractures comprise 3-6% of all paediatric fractures, and they offer a challenge to their treatment. The purpose of this study was to evaluate the incidence of diaphyseal both-bone forearm fractures in children during the last decade in Northern Finland. Another objective was to study the background factors, treatment, and re-displacement of these fractures., Materials and Methods: All 168 children (<16 years) admitted to our paediatric trauma centre due to diaphyseal both-bone forearm fractures during 2000-2009 were included. The type of injury, background factors, radiographics, treatments and re-dislocations were reviewed. The age-related incidence rates were evaluated., Results: The incidence of diaphyseal both-bone forearm fractures increased 4.4-fold (95% CI 2.0-10.8; P<0.001) between 2000 (8.2/100000) and 2009 (35.9/100000). The increase in the incidence was accelerating (P<0.001) and the overall increase was 338%. The incidence of surgical treatment for diaphyseal fractures increased 4.2-fold (95% CI 1.9-10.4, P=0.001), which is in relation to increasing number of fractures. However, internal fixation increased from 13.3% in 2000-2001 to 52.7% in 2008-2009 (P=0.015), as an alternative to conservative treatment. The re-displacement rate was high (29.9%) amongst the patients with conservative treatment compared to those who were invasively operated (1.4%) (P<0.001). The mean age of the patients increased by 2.4 years in the study period (P=0.019). Trampoline was the most important and still increasing reason for the fractures. At the beginning of the study, there were no trampoline-related fracture, but towards the end of the study 30-41% of the fractures were caused by a trampoline injury (P=0.004)., Conclusions: There was an accelerating increase in the incidence of paediatric diaphyseal both-bone forearm fractures during the last decade. Trampoline was the most important and still increasing reason for these fractures. The mean age of the patients was increasing. Increasing proportion of diaphyseal both-bone forearm fractures was treated operatively. Re-displacement was unusual amongst operated cases., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Radial nerve palsy associated with humeral shaft fractures is the most common nerve lesion complicating fractures of long bones. The purpose of the study was to review the outcome of surgical management in patients with low energy and high energy radial nerve palsy after humeral shaft fractures., Methods: Eighteen patients were treated operatively for a humeral shaft fracture with radial nerve palsy. The mean age was 32.2 years and the mean follow up time was 66.1 months (range: 30-104). The surgical management included fracture fixation with early nerve exploration and repair if needed. The patients were divided in two groups based on the energy of trauma (low vs. high trauma energy). The prevalence of injured and unrecovered nerves and time to nerve recovery were analysed., Results: Five patients sustained low and 13 high energy trauma. All patients with low energy trauma had an intact (4) or entrapped (1) radial nerve and recovered completely. Full nerve recovery was also achieved in five of 13 patients with high energy trauma where the nerve was found intact or entrapped. Signs of initial recovery were present in a mean of 3.2 weeks (range: 1-8) for the low energy group and 12 weeks (range: 3-23) for the high energy group (p=0.036). In these patients, the average time to full recovery was 14 and 26 weeks for the low and high energy trauma group respectively. Eight patients with high energy trauma had severely damaged nerves and failed to recover, although microsurgical nerve reconstruction was performed in 4 cases. Patients with high energy trauma had a prolonged fracture healing time (18.7 weeks on average) compared to those with low energy fractures (10.4 weeks), (p=0.003)., Conclusions: The outcome of the radial nerve palsy following humeral fractures is associated to the initial trauma. Palsies that are part of a low energy fracture uniformly recover and therefore primary surgical exploration seems unnecessary. In high energy fractures, neurotmesis or severe contusion must be expected. In this case nerve recovery is unfavourable and the patients should be informed of the poor prognosis and the need of tendon transfers., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Several aspects of the management of displaced supracondylar fractures in children remain controversial. Displaced supracondylar humeral fractures (Type III) in children have traditionally been considered orthopaedic emergencies. Recent studies have suggested that closed Type III supracondylar fractures without vascular compromise may be treated in a delayed manner without compromise to functional and cosmetic outcome. Debate continues over the fixation method of choice in these difficult fractures. A postal questionnaire of 121 practising paediatric orthopaedic consultants in the UK was performed to explore these issues. Seventy-seven replies were obtained (63.6%). The 54.5% of the respondents managed displaced supracondylar fractures without vascular compromise in a delayed manner (more than 8h from presentation). The incidence, initial assessment and factors which influence the timing of surgery of these fractures are discussed. The fixation method of choice reported was closed reduction and the use of smooth Kirshner wires (93.4%). Of these, crossed pin fixation is used by 83.9% of respondents and 9.7% employed laterally placed wires. The majority of consultants (69.7%) considered the operative treatment of these fractures a consultant-led procedure. This survey has established an overview of the current practices of paediatric orthopaedic consultants in the UK in the management of these difficult fractures.

Open long bone fractures occur with a frequency of 11.5 per 100,000 persons per year. They are more common in males and they have a bimodal age distribution. Open fractures of the tibial diaphysis are the commonest, but open femoral diaphyseal, distal femoral and proximal tibial fractures tend to occur in the most seriously injured patients. Lower limb open fractures are more severe than open fractures of the upper limbs. Not only is the soft tissue damage less in open upper limb fractures, but there are fewer associated musculoskeletal injuries.

In order to test the hypothesis that the volume of paediatric orthopaedic trauma is related to the weather, we analysed all children with fractures admitted to our unit over a 3-year period and correlated this information with local meteorological data. The average number of children admitted per month with fractures showed a strong positive correlation with mean monthly sunshine hours (Pearson correlation coefficient 0.91) and a weak negative correlation with mean monthly rainfall (-0.24). The summer peak in the incidence of fractures persisted when the effect of school holidays was eliminated. Fractures involving the radius accounted for 48.7 per cent of all fracture admissions and correlation with sunshine hours was highest in this group. Almost two-thirds of all fracture admissions were male and these had a slightly higher mean age (8.2 years) than females (7.6 years). This data has implications for bed management and staffing levels in a paediatric orthopaedic unit.

The incidence of various fractures resulting from falls onto the outstretched hand in a Transkeian population was compared to that in a British population. Large differences were found, fractures of the distal humerus being much more common in Transkei, as were 'juvenile Colles' ' fractures. Fractures of the clavicle and radial head were correspondingly less common and fractures of the scaphoid were not seen in Transkei. Possible reasons for these differences are discussed.