Background: Hip fractures in geriatric patients represent a major public health burden, with a clinically important subset presenting with concomitant upper extremity (UE) fractures. The independent impact of these dual injuries on clinical outcomes remains incompletely characterized. Methods: A retrospective study of patients aged ≥65 years who underwent surgical treatment for hip fracture at tertiary medical center, between January 2010 and January 2024. Patients were stratified based on the presence of a UE fracture sustained at the same time as the hip fracture. Multivariable regression models were used to assess outcomes, adjusting for age, sex, hip fracture type, and comorbidity burden. Primary outcomes were hospital length of stay and mortality at 30 days and 1 year. Secondary outcomes included readmission rates, revision surgery, and infection complications. Results: Of 7488 patients, 251 (3.4%) had concomitant upper extremity (UE) fractures. These patients had a longer mean hospital stay compared with isolated hip fractures (20.2 vs. 17.5 days, p = 0.047), with no significant difference in 30-day mortality (p = 0.439) and a trend toward lower 1-year mortality (p = 0.058). In the concomitant UE fracture group, operative treatment was associated with longer hospitalization (26.2 vs. 19.2 days, p = 0.05) and higher revision surgery rates (14.0% vs. 3.1%, p = 0.01). Subgroup analyses by fracture type showed similar trends, with longer hospital stays observed in intracapsular fractures with concomitant injury (p = 0.05). Subgroup analysis by UE fracture location showed significantly longer stays for distal radius fractures compared with isolated hip fractures, whereas no significant differences were observed for proximal humerus or other UE fracture locations. Conclusions: Concomitant UE fractures in geriatric hip fracture patients are associated with prolonged hospitalization. Operative management of UE fractures results in longer hospital stays and an increased risk of revision surgery. These findings highlight the importance of tailored perioperative planning and resource allocation for this vulnerable patient group.

Background and Objectives: To evaluate the association of surgeon experience, simulation-based training, and hand dominance on drilling accuracy using a synthetic bone model, with the hypothesis that training improves resident performance and left-handed individuals show superior bilateral accuracy. Materials and Methods: A prospective observational study was conducted in the Orthopedic Surgery Division of a tertiary academic center. Drilling accuracy was assessed before and after a standardized simulation-based training program. Twenty-five orthopedic surgeons participated: 9 junior residents (≤3 years of training), 8 senior residents (>3 years), and 8 board-certified experts. All participants completed baseline assessments; only residents were evaluated immediately after training and at a 2-week follow-up. Results: Experts showed superior baseline accuracy, particularly with the non-dominant hand. Senior residents showed a significant overall effect of time on right-hand accuracy (F(2,14) = 5.85, p = 0.014); post hoc pairwise comparisons showed trends toward improvement from baseline to post-training (p = 0.06) and from post-training to 2-week follow-up (p = 0.105); Junior residents showed no significant changes. Left-handed participants consistently outperformed right-handed peers with their non-dominant hands (p = 0.034). Among residents, this pattern persisted across all sessions. At baseline, senior residents and experts had similar right-hand accuracy (p = 0.59), but senior residents performed worse with the left hand (p = 0.038). No significant differences were found between junior and senior residents in either hand across all time points, indicating that residency duration alone does not improve performance without targeted training. Conclusions: Drilling accuracy in orthopedic surgery is influenced by experience level, targeted training, and hand dominance. Experts show greater precision, and senior residents showed a significant overall effect of time on right-hand accuracy, with trends toward improvement following training, while junior residents may need different training strategies. Tailored educational interventions are needed to improve accuracy and ambidexterity across all training stages. Level of evidence: II.