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.

Purpose: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF. Methods: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group. Results: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results. Conclusions: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed.

Benign intra-articular soft tissue tumors can mimic septic arthritis of the hip (SAH), posing a significant diagnostic challenge. Timely differentiation between these entities is crucial, as SAH requires urgent intervention to prevent adverse outcomes. The present study aims to (1) examine clinical presentations, imaging findings, laboratory results, and histopathological features associated with benign intra-articular soft tissue tumors mimicking SAH and (2) describe diagnostic challenges encountered in treating these patients. A retrospective review identified 23 patients who underwent arthroscopic irrigation and debridement for suspected SAH at a single institution between 2014-2023. Seven patients with negative cultures and intraoperative diagnoses of intra-articular tumors confirmed by histopathology were included in the primary analysis. Clinical presentations, imaging findings, laboratory results, arthroscopic findings, histopathology results, and follow-up data were analyzed. A comparison with the non-tumor cases (n = 16) was performed as a secondary analysis. The mean age of the tumor group was 25.0 ± 8.1 years and a female predominance (6/7, 85.7%) was observed. All patients presented with acute hip pain, limited range of motion, and elevated C-reactive protein levels (80.0 ± 38.3 mg/L). Three patients presented with fever and three with leukocytosis. Synovial fluid white blood cell counts exceeded 50,000 cells/μL in five patients. Arthroscopy revealed solid tumors in all cases. Tumor necrosis was observed in all cases and tenosynovial giant cell tumor (TGCT) was confirmed histologically in six cases (6/7, 85.7%). Postoperative MRI in four patients showed no tumor recurrence. Compared to the non-tumor group, patients with tumors were significantly younger (p = .016) and had lower preoperative CRP levels (p = .027). Differentiating benign intra-articular tumors from SAH remains difficult, particularly among younger and female patient populations with acute presentations of TGCT which, as observed in the present study, may be explained by histopathologic evidence of tumor pedicle torsion and resultant necrosis. MRI can be valuable in identifying intra-articular lesions given that clinical and laboratory findings are frequently equivocal. The proposed diagnostic algorithm offers a framework for identifying cases where preoperative MRI may be beneficial, though it requires validation in larger studies.