{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:28:35Z","timestamp":1786444115784,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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\u20132022). 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 \u226565 years), 3884 (6.1%) met polytrauma criteria (ISS \u2265 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\u20138.09) and non-home discharge among survivors (aOR 1.95, 95% CI 1.79\u20132.12; crude 72.0% vs. 64.6%). ICU utilization (aOR 13.25, 95% CI 12.34\u201314.22) and any complication (aOR 3.41, 95% CI 3.07\u20133.79) 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.<\/jats:p>","DOI":"10.3390\/jcm15166210","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:11:16Z","timestamp":1786439476000},"page":"6210","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concomitant Polytrauma in Fall-Related Proximal Humerus Fractures: A Fracture-Subtype-Stratified Analysis of In-Hospital Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1938-1232","authenticated-orcid":false,"given":"Abdullah","family":"Raizah","sequence":"first","affiliation":[{"name":"Orthopedic Department, College of Medicine, King Khalid University, Abha 62521, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of Adult Fractures: A Review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s11657-015-0209-4","article-title":"Epidemiology of Proximal Humerus Fractures","volume":"10","author":"Launonen","year":"2015","journal-title":"Arch. Osteoporos."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s13018-021-02551-x","article-title":"Epidemiology of Proximal Humerus Fractures","volume":"16","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.jseint.2021.12.003","article-title":"Proximal Humerus Fractures: Epidemiology and Trends in Surgical Management of Hospital-Admitted Patients in Portugal","volume":"6","author":"Linhares","year":"2022","journal-title":"JSES Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00198-018-4500-2","article-title":"Incidence and Outcomes of Humeral Fractures in the Older Person","volume":"29","author":"Wang","year":"2018","journal-title":"Osteoporos. Int."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Martinez-Huedo, M., Jim\u00e9nez-Garc\u00eda, R., Mora-Zamorano, E., Hern\u00e1ndez-Barrera, V., Villanueva-Martinez, M., and Lopez-de-Andres, A. (2017). Trends in Incidence of Proximal Humerus Fractures, Surgical Procedures and Outcomes among Elderly Hospitalized Patients with and without Type 2 Diabetes in Spain (2001\u20132013). BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1892-7"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1302\/0301-620X.96B7.32894","article-title":"The Outcome of Proximal Humeral Fractures in the Elderly","volume":"96-B","author":"Clement","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s11657-023-01260-8","article-title":"Prognostic Factors and Prediction Model for 1-Year Mortality after Proximal Humeral Fracture","volume":"18","author":"Janssens","year":"2023","journal-title":"Arch. Osteoporos."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e001055","DOI":"10.1136\/tsaco-2022-001055","article-title":"A Nationwide Analysis of Geriatric Proximal Humerus Fractures: Trends, Outcomes, and Cost","volume":"8","author":"Cheng","year":"2023","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00590-020-02734-y","article-title":"Plate Fixation versus Intramedullary Nailing of Proximal Humerus Fractures: An ACS NSQIP-Based Comparative Analysis over 8 Years","volume":"31","author":"Burgmeier","year":"2021","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S345","DOI":"10.1097\/TA.0b013e318270191f","article-title":"Evaluation and Management of Geriatric Trauma","volume":"73","author":"Calland","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1097\/TA.0000000000000453","article-title":"The Definition of Polytrauma Revisited","volume":"77","author":"Pape","year":"2014","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1016\/j.injury.2009.10.032","article-title":"The Definition of Polytrauma: The Need for International Consensus","volume":"40","author":"Butcher","year":"2009","journal-title":"Injury"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"147","author":"Altman","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.jamcollsurg.2012.08.017","article-title":"Methodology and Analytic Rationale for the American College of Surgeons Trauma Quality Improvement Program","volume":"216","author":"Newgard","year":"2013","journal-title":"J. Am. Coll. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13017-024-00537-8","article-title":"The 2023 WSES Guidelines on the Management of Trauma in Elderly and Frail Patients","volume":"19","author":"Chouillard","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1001\/jamasurg.2014.296","article-title":"Superiority of Frailty Over Age in Predicting Outcomes Among Geriatric Trauma Patients","volume":"149","author":"Joseph","year":"2014","journal-title":"JAMA Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivar. Behav. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal Caliper Widths for Propensity-score Matching When Estimating Differences in Means and Differences in Proportions in Observational Studies","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm. Stat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1007\/s00068-021-01772-3","article-title":"Pelvic Fractures in Severely Injured Elderly: A Double-Adjustment Propensity Score Matched Analysis from a Level I Trauma Center","volume":"48","author":"Gogna","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance Diagnostics for Comparing the Distribution of Baseline Covariates between Treatment Groups in Propensity-score Matched Samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2151458517728155","DOI":"10.1177\/2151458517728155","article-title":"Predictors of Mortality in Elder Patients with Proximal Humeral Fracture","volume":"9","author":"Myeroff","year":"2018","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.amjsurg.2015.12.018","article-title":"Post-Trauma Mortality Increase at Age 60: A Cutoff for Defining Elderly?","volume":"212","author":"Moore","year":"2016","journal-title":"Am. J. Surg."},{"key":"ref_24","first-page":"CD000434","article-title":"Interventions for Treating Proximal Humeral Fractures in Adults","volume":"2022","author":"Handoll","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.jse.2023.07.012","article-title":"Geriatric Proximal Humerus Fracture Operative Management: A Truven Health Analytics Database Study (2015\u20132020)","volume":"33","author":"Klahs","year":"2024","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6641","DOI":"10.1007\/s00402-023-04993-w","article-title":"Orthogeriatric Care-Outcome of Different Fragility Fractures","volume":"143","author":"Pankratz","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/TA.0000000000003406","article-title":"Improving Mortality in Older Adult Trauma Patients: Are We Doing Better?","volume":"92","author":"Karam","year":"2022","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"111091","DOI":"10.1016\/j.injury.2023.111091","article-title":"Blood Transfusion and Surgical Treatment Increase Mortality in Patient with Proximal Humeral Fractures","volume":"54","year":"2023","journal-title":"Injury"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1142\/S2424835518500303","article-title":"Venous Thromboembolism in Upper Extremity Fractures","volume":"23","author":"Nayar","year":"2018","journal-title":"J. Hand Surg. Asian-Pac. Vol."},{"key":"ref_30","first-page":"e70083","article-title":"Predictive Factors for Poor Prognosis in Non-Surgical Treatment of Proximal Humerus Fractures in Elderly Patients","volume":"16","author":"Beraldo","year":"2024","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1097\/01.TA.0000119689.81910.06","article-title":"Factors Associated with Mortality in Trauma: Re-Evaluation of the TRISS Method Using the National Trauma Data Bank","volume":"56","author":"Millham","year":"2004","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.surg.2023.05.006","article-title":"Outcomes after Stairway Falls in a Rural Appalachian Trauma Center","volume":"174","author":"Zaskey","year":"2023","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/TA.0000000000003696","article-title":"Falls from Ladders: Injury Patterns and Outcomes","volume":"93","author":"Liasidis","year":"2022","journal-title":"J. Trauma Acute Care Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6210\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:32:21Z","timestamp":1786440741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":33,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166210"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166210","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}