Geriatric Orthopaedic Surgery & Rehabilitation · Oct 18, 2026
Mortality Following Proximal Humerus Fractures in Elderly Patients: A Retrospective Cohort Study of Clinical and Laboratory Predictors
By Demirtaş İ, Kilinç Ö, Tanrıkulu AN et al.
Background: Proximal humerus fractures in older adults are increasingly recognized as fragility injuries associated with substantial morbidity and mortality. However, factors independently associated with mortality in elderly patients with proximal humerus fractures remain incompletely understood. Methods: This retrospective single-center cohort study included consecutive patients aged ≥65 years treated for proximal humerus fractures between February 2017 and June 2024. Demographic characteristics, treatment-related variables, comorbidity burden, and laboratory findings were collected from institutional records. Mortality data were obtained from the national civil registration system. Survival time was defined from the date of injury to death or final mortality status assessment. Univariable analyses and multivariable Cox proportional hazards regression were performed to identify independent predictors of mortality. Results: A total of 261 patients were included, of whom 34 (13.0%) died during follow-up. Non-survivors were significantly older and demonstrated higher Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists scores, longer hospital stays, and lower rates of surgical treatment. Laboratory analyses showed significantly lower hemoglobin, hematocrit, platelet count, lymphocyte count, and albumin levels, and higher urea and creatinine levels among non-survivors. In multivariable Cox regression, higher CCI was independently associated with increased mortality (HR: 1.47, 95% CI: 1.25–1.73; p<0.001), whereas higher albumin (HR: 0.26, 95% CI: 0.15–0.45; p<0.001) and platelet count (HR: 0.91, 95% CI: 0.86–0.96; p=0.001) were associated with lower mortality risk. Conclusions: Mortality after proximal humerus fractures in elderly patients appears to be associated with comorbidity burden and markers of systemic physiological vulnerability. Higher CCI, lower serum albumin, and lower platelet count were independently associated with mortality. These routinely available clinical and laboratory parameters may assist in early risk stratification and identification of high-risk individuals in clinical practice.