Summary The AHFS⁹⁰ was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS⁹⁰ has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS⁹⁰ yielded a maximum prediction of early mortality of 64.5%. Purpose Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS⁹⁰). Methods Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS⁹⁰, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. Results One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS⁹⁰ includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS⁹⁰ had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS⁹⁰ overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS⁹⁰ had a maximal prediction of early mortality of 64.5% in this study population. Conclusion The AHFS⁹⁰ accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS⁹⁰ yielded a maximum prediction of early mortality of 64.5%.

(1) Background: Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed to determine whether the operatively treated geriatric hip fracture population would have a lower in-hospital mortality rate and fewer postoperative complications after the introduction of NOM within a palliative care context for patients with very limited life expectancy. (2) Methods: Data from 1 February 2019 to 1 February 2022 of patients aged 70 years or older were analyzed to give a comparison between patients before and after implementation of NOM within a palliative care context. (3) Results: Comparison between 550 patients before and 485 patients after implementation showed no significant difference in in-hospital or 1-year mortality rates (2.9% vs. 1.4%, p = 0.139; 22.4% vs. 20.2%, p = 0.404, respectively). Notably, post-implementation, fewer patients had prior dementia diagnoses (15% vs. 21%, p = 0.010), and intensive care unit admissions decreased (3.5% vs. 1.2%, p = 0.025). (4) Conclusions: The implementation of NOM within a palliative care context did not significantly reduce mortality or complications. However, NOM within palliative care is deemed a more patient-centered approach for geriatric hip fracture patients with very limited life expectancy.

Case: Fracture of a sesamoid bone of the thumb is rare. We report a case of such a fracture after hyperextension of the thumb in a 26-year-old woman. After a volar plate injury was excluded, she was treated nonoperatively with 5 weeks of immobilization followed by physical therapy. Conclusion: After reviewing the current literature describing sesamoid fractures of the thumb, we recommend that fracture of the sesamoid of the metacarpophalangeal (MCP) joint should be regarded as an avulsion fracture. The role of surgical intervention should be limited to patients with a painful nonunion.

Background: Internationally, the optimal treatment strategy of proximal humerus fractures remains much debated. Methods: To investigate whether operative treatment of displaced proximal humerus fractures is superior to nonoperative treatment, this international multicenter prospective natural experiment based on clinical equipoise was performed. Two hundred twenty-six patients with acute proximal humerus fractures presenting from July 2020 to March 2022 were included after expert panel evaluation, consisting of Dutch and Swiss surgeons with diverse ideas on optimal treatment. Patients were included when no consensus on optimal treatment was reached i.e., clinical equipoise. Follow-up was completed after 1 year (n = 191 [84%]). The primary outcome was Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) after 1 year. Secondary outcomes included QuickDASH at 6 weeks and EQ5D, Subjective Shoulder Value (SSV), Numeric Rating Scale (NRS) for pain at 6 weeks and 1 year. Results: No difference in QuickDASH score after 1 year (12.8 vs. 16.2, p = 0.73) was found. At 6 weeks, operative treatment resulted in lower NRS (4.3 vs. 3.0, p < 0.001), higher EQ5D (0.59 vs. 0.67, p = 0.011), and higher SSV (40.9 vs. 51.4, p = 0.005). At 1 year, operative treatment resulted in higher SSV (72.1 vs. 83.7, p = 0.002), while EQ5D was comparable (0.87 vs. 0.85, p = 0.95). Conclusion: No difference between treatments was observed in the primary outcome. Patient-tailored care may still include counseling operative treatment to patients to reduce short-term pain and/or facilitate early return to sport/work in young active patients. Level of Evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.

Objectives: The aim of this study was to determine the variations in effect for predictors of mortality over time and risk of in-hospital complications in geriatric patients with a hip fracture. Many studies have investigated risk factors of short-term and long-term mortality separately. In current literature, little is known about the variations in effect of risk factors over time and no comparison with the general population is made. Methods: All patients with a hip fracture aged 70 years or older admitted to our hospital between January 1, 2016, and May 1, 2018, were included in this retrospective study. Patients who had undergone total hip arthroplasty (THA) were not included. The primary outcome was mortality after 1 year. Secondary outcomes were mortality after 30 days, 90 days, 2 years, and complications. Kaplan–Meier (KM) curves for risk factors were generated to visualize survival over time. Data were compared with data extracted from the national health records. Results: A total of 685 geriatric patients with hip fractures were included with a 1-year mortality of 27%. The adjusted odds ratios (AOR) found differed over time. Five risk factors for mortality were investigated in this study using KM curves: age, prefracture living situation, dementia, sex, and ASA classification. Conclusions: Over time, the variation of 5 risk factors for mortality were visualized in geriatric patients with a hip fracture: age, prefracture living situation, dementia, sex, and ASA classification. An elevated risk of mortality was discovered compared with the general population. The variation in effect observed in risk factors plays a vital role in prognosis. This insight will help guide accurate medical decision-making for a tailored treatment plan for geriatric patients with a hip fracture.