Concomitant Polytrauma in Fall-Related Proximal Humerus Fractures: A Fracture-Subtype-Stratified Analysis of In-Hospital Outcomes.

Objectives

To determine whether concomitant polytrauma is independently associated with worse in-hospital outcomes among fall-related proximal humerus fracture (PHF) patients and whether fracture subtype is associated with heterogeneity in this association.

Methods

Retrospective cohort study using the American College of Surgeons Trauma Quality Program Participant Use File (ACS TQP-PUF; 2019-2022). Adults with PHF and a fall mechanism were included. Multivariable logistic regression adjusted for age, sex, the five mFI-5 components, anticoagulant use, and calendar year. Non-home discharge (NHD) was restricted to survivors. Sensitivity analyses used 1:1 PSM (all primary covariates in propensity model; post-matching SMDs assessed) and restriction to ground-level falls.

Results

Among 63,995 fall-related PHF patients (70.5% female; 75.8% aged ≥65 years), 3884 (6.1%) met polytrauma criteria (ISS ≥ 16); polytrauma patients were more often male (45.1% vs. 28.5%) and slightly younger (mean age 69.3 vs. 72.0 years). Polytrauma was independently associated with in-hospital mortality (aOR 7.05, 95% CI 6.14-8.09) and non-home discharge among survivors (aOR 1.95, 95% CI 1.79-2.12; crude 72.0% vs. 64.6%). ICU utilization (aOR 13.25, 95% CI 12.34-14.22) and any complication (aOR 3.41, 95% CI 3.07-3.79) are reported as descriptive markers subject to triage and ascertainment bias, respectively. The ICD-10 subtype-stratified mortality aORs ranged from 3.36 to 8.28 across five strata (exploratory; no formal interaction test performed). PSM (3884 pairs; n = 7768) and ground-level fall restriction produced estimates consistent with the primary analyses.

Conclusions

Concomitant polytrauma was independently associated with substantially higher in-hospital mortality and non-home discharge after fall-related PHF, identifying a high-risk subgroup that warrants closer clinical attention.