Concomitant fractures in older patients with proximal femoral fractures: rib fractures are associated with increased complications and mortality for consideration in european geriatric medicine.

PURPOSE: Proximal femoral fractures (PFF) are a global health burden in aging populations. Evidence on the prevalence and clinical relevance of concomitant fractures in this population remains limited. This study investigated the impact of concomitant fractures on mortality, complications, transfusion requirements, and postoperative mobility in patients with geriatric PFF. METHODS: This single-center cohort study included patients ≥ 65 years with a positive geriatric screening, who underwent surgery for a PFF after low-energy trauma between January 2019 and December 2023. Patients with concomitant fractures were compared with those with isolated PFF. Outcomes included mortality, perioperative parameters, complications, and mobility at discharge. Uni- and multivariable regression models were applied adjusting for age, sex, comorbidities, body mass index (BMI), and fracture type. RESULTS: A total of 1553 patients were analyzed; 164 (10.5%) sustained concomitant fractures (n = 180), most commonly of the upper limb (57%), pelvis (16%), and ribs (13%). Concomitant fractures were ipsilateral in 89% and surgically treated in 29%. Compared with isolated PFF, these patients had higher rates of in-house venous thromboembolism (VTE) (5.5% vs. 0.9%, p < 0.001), required 0.4 more units of blood transfusion (95% confidence interval (CI) 0.114-0.744), and showed impaired mobilization at discharge (odds ratio (OR) 0.5, 95%CI 0.328-0.654). No difference in overall in-house or 90-day mortality was observed. However, concomitant rib fractures markedly increased the risk of non-surgical complications (OR 2.8, 95%CI 1.175-6.804), VTE (OR 14.8, 95%CI 4.078-53.492), blood transfusion by 1.1 units (95%CI 0.323-1.925), and 90-day mortality (OR 6.4, 95%CI 2.675-15.469). CONCLUSION: Concomitant fractures occur in over 10% of geriatric PFF patients and worsen clinical outcomes, particularly VTE risk, transfusion needs, and mobility. Rib fractures are a high-risk subgroup requiring specific clinical attention.