Morbidity and mortality of surgically treated proximal humerus fractures | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

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Isart, J.F. Sánchez, F. Santana, L. Puig, E. Cáceres, C. Torrens" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Isart" "email" => array:1 [ 0 => "isartanna@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.F." "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Santana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Puig" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Cáceres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "C." "apellidos" => "Torrens" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Institut Universitari Dexeus (ICATME), Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1076 "Ancho" => 1315 "Tamanyo" => 49295 ] ] "descripcion" => array:1 [ "en" => "Distribution of patients." ] ] ] "textoCompleto" => "IntroductionProximal humerus fractures have increased dramatically in the last 30 years. Not only has the total number of fractures risen, but also the mean age of patients has gone from 73 years in 1970–1978 years in 2002. Even the complexity of the fracture patterns has increased over this period.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>Despite the fact that most of these fractures are not displaced and can be treated conservatively, there is no consensus on the best treatment option in displaced proximal humeral fractures. While some authors are in favor of a conservative approach, others recommend surgical treatment.<a class="elsevierStyleCrossRefs" href="#bib0015">3–9</a>Most proximal humerus fractures in patients of advanced age can be attributed to osteoporosis. Those who suffer fractures of the proximal humerus most often present subsequent osteoporotic fractures. In spite of this knowledge, scarce attention has been paid to the diagnosis and treatment of the underlying osteoporosis.<a class="elsevierStyleCrossRefs" href="#bib0050">10–12</a>Proximal humerus fractures are associated to a higher mortality, especially among males. Nevertheless, very few studies to date have analyzed the mortality and capacity to carry out daily life activities (DLA) among patients suffering proximal humerus fractures and undergoing surgical treatment, compared to those suffering hip fractures.<a class="elsevierStyleCrossRefs" href="#bib0065">13–23</a>The objective of this study is to analyze the factors correlating mortality and the capacity to perform DLA among patients with proximal humerus fractures treated surgically.MethodsWe conducted a retrospective study after prospectively gathering data from 94 patients undergoing surgical treatment of proximal humerus fractures at our center, of which we were only able to locate 72. The sample included 20 males and 74 females, with a mean age of 72 years (range: 50–89 years), of which 17 patients were aged between 50 and 65 years, 35 between 66 and 80 years and 20 between 80 and 89 years. The right shoulder was affected in 56 cases and in the majority of cases (86.5%) it was the dominant arm.The inclusion criteria considered in this study described patients arriving at our hospital between the years 2000 and 2001, with a diagnosis of proximal humerus fracture, undergoing surgical treatment and aged 50 years or over.The exclusion criteria included all those patients who attended during the same period due to proximal humerus fractures which were treated conservatively and those aged less than 50 years.All cases were diagnosed with fracture of the proximal humerus following a radiographic study in 2 projections (AP and profile in the plane of the scapula), as well as a computed tomography (CT) scan for correct classification. Fractures were classified according to the Neer classification,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> resulting in the following distribution: 33 fractures in 2 fragments (17 fractures of the surgical neck, 9 fractures of the anatomical neck, 7 fractures of the greater tuberosity), 44 fractures in 3 fragments (40 fractures of the greater tuberosity, 4 fractures of the lesser tuberosity), 9 fractures in 4 fragments, 2 fracture-dislocations in 2 fragments, 2 fracture-dislocations in 3 fragments and 4 fracture-dislocations in 4 fragments.The patients studied underwent different surgical treatments depending on the type of fracture, age and criteria of the surgeon. Of these, 40 were intervened through isolated transosseous sutures, 27 through transosseous sutures associated to Ender nails, 3 through placement of angular stability plates, 22 through hemiarthroplasties and 2 through inverted prostheses.All patients were reviewed in order to obtain data on: (a) mortality, (b) subsequent fractures, (c) the level of satisfaction with the function of the affected shoulder (stratified into 3 categories: very satisfactory, satisfactory and not satisfactory) and d) the level of dependence or independence for DLA (assessed through 4 questions [<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>] which established whether the patient was capable/incapable of DLA, with this variable being qualitative).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>We also reviewed comorbidities (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) at the time of the fracture. In total, 12 of the 72 patients did not present comorbidities at the time of the fracture, whilst the rest presented more than 1 comorbidity.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Statistical analysisCategorical variables were described through frequencies and percentages and quantitative variables through mean and standard deviation. The bivariate analysis was carried out through the Chi-squared test or Fisher's exact test in the case of categorical variables, the Student's t test for independent data and the analysis of variance (ANOVA) to compare quantitative variables.Lastly, we used a multivariate model of binary logistical regression to assess the factors related to autonomy. In all cases we considered as statistically significant values of P<.05. The statistical analysis was carried out with the software package SPSS 18.0 (SPSS Inc., Chicago, IL, USA).ResultsThe distribution of patients is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Of the 14 deceased patients, 9 cases involved the right shoulder and 3 cases involved the left shoulder, with 10 patients being right-handed and 2 being left-handed, and with a mean period of 4.2 years (range: 0.5–9 years) since the intervention until death in the right shoulder group and 3 years (range: 3–10 years) in the left shoulder group. Only 1 case died during the first year after the intervention (the patient had a history of mammary carcinoma), for causes unrelated to the fracture of the proximal humerus.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The distribution of mortality according to the type of fracture was as follows: 2 deaths among patients with fractures in 2 parts, 5 among patients with fractures in 3 parts, 3 among patients with fractures in 4 parts and 1 in a patient with a fracture-dislocation in 4 parts. No statistically significant correlation between mortality and the type of fracture was observed (P=.362).We observed less deaths among patients treated with transosseous sutures (3 patients), whereas the number of deaths increased slightly among those treated by transosseous suture and Ender nails (7 patients), without reaching statistical significance (P=.92). The mode of treatment was not correlated with mortality (P=.145). We obtained a statistically significant correlation between age and the treatment applied, with those patients treated by prosthesis, transosseous sutures and Ender nails being older than the rest (P=.003).We found a greater number of comorbidities among deceased patients. Respiratory disease was not present in any case of death, whereas metabolic disease was present in 13 cases, heart disorders in 4 and neurological disorders in 2 cases. In general, all deceased patients presented more than 1 comorbidity.There were 4 deaths among patients who were diagnosed with osteoporosis prior to the fracture (all of them through bone densitometry). All osteoporotic patients with no comorbidity were still alive at the time of the interview.Regarding the level of dependence for DLA, nearly all of the patients (79.5%) were totally independent for daily life activities at the end of the follow-up period. We found no significant correlation between the type of fracture and autonomy for DLA (P=.612). We observed that the type of treatment had a significant influence on the final autonomy for DLA of the 35 patients treated with transosseous suture, with 32/35 (91.4%) being totally independent. Of the 17 patients treated with transosseous sutures and Ender nails, 13/17 (76.5%) were independent, whilst among those treated with an angular stability plate or shoulder prosthesis, only 50% were fully independent for DLA (P=.006).Out of the 13 patients with neurological disorders, only 53.8% were autonomous for DLA. Patients suffering Parkinson's disease and different types of dementia were already dependent before the intervention, as well as 1 patient who had been previously diagnosed with Ménière syndrome, 1 with essential tremor and 2 with depression who ceased to be independent for DLA after suffering the fracture and subsequent intervention.A statistically significant correlation was found between neurological disorders and a lack of autonomy for DLA (P=.028). Conversely, heart disease, respiratory disease and metabolic disease did not worsen the capacity for DLA.No significant correlation was found in relation to capacity for DLA between patients diagnosed with osteoporosis at the time of the fracture or subsequently to the fracture (P=.672).In 18 patients (24%) we found other fractures after the proximal humerus fracture, including: 9 fractures of the proximal end of the femur, 4 vertebral fractures, 5 fractures of the distal radius, 2 clavicular fractures, 1 bimalleolar ankle fracture, 1 patellar fracture, 1 fracture of the contralateral proximal humerus and 1 fracture in the metacarpus of the hand.Only 61.1% of those who suffered associated fractures continued to be autonomous for activities of daily life. Patients without additional fractures were significantly more autonomous for DLA than those who suffered other fractures (P=.05).Only 11.3% of patients had been previously diagnosed and treated for their osteoporosis before the proximal humeral fracture. This condition did not significantly affect the type of fracture or the presence of additional fractures (P=.283) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In total, 59.4% of patients described the result obtained in their shoulder as very satisfactory, 32.8% as satisfactory and 7.8% as unsatisfactory. Satisfaction was significantly correlated with autonomy for DLA at the end of the follow-up period (P=.003).DiscussionThe best treatment option for proximal humerus fractures has not yet been defined. At the time of deciding on the treatment, the surgeon must take into account the fact that patients treated by surgery have a high mortality rate, especially those presenting comorbidities. In the present study, patients with surgically treated proximal humerus fractures who presented comorbidities seemed to have a higher mortality risk. On the other hand, the majority of surgically treated patients who remained alive at the end of the follow-up period remained autonomous and were able to live independently, except for those with neurological comorbidities.In our study of proximal humerus fractures treated surgically, mortality during the first year was limited to 1 patient. This lower mortality rate during the first year can be explained by the fact that patients eligible for surgery are generally those who are most suitable and do not present serious diseases. Despite the fact that 85.4% of the patients included presented some comorbidity at the time of the fracture, this did not significantly harm patients.Mortality increased to 18.6% throughout the follow-up period (with a mean duration of 8 years), significantly higher than the mortality rate expected in a group of comparable age and gender in Spain, according to the National Statistics Institute (the combined rate of deaths among males and females at the age of 72 years was of 16.67 per 1000 in 2012).<a class="elsevierStyleCrossRef" href="#bib0125">25</a> We only found deaths in patients with comorbidity at the time of the fracture and with no correlation with the type of fracture or the treatment applied, which means that special attention should be paid to comorbidities when facing the decision of applying surgical treatment to proximal humerus fractures, although in our study we did not identify a significant relationship. A study conducted on a sample French population found a mortality rate of 9.1% in patients with proximal humerus fractures and a mean follow-up period of 4 years.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Another work in the same line of analysis found a mortality rate of 0.6% after 1 year of having suffered a proximal humerus fracture treated conservatively.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>The results obtained in this work indicate that the majority of patients who underwent surgery due to fractures of the proximal humerus and who were in good condition in terms of autonomy and capacity for DLA, did not vary after the treatment. When comparing quality of life through the HRQol test between elderly patients intervened due to fractures of the proximal humerus and those treated conservatively, similar studies, such as that by Fjalestad et al. obtained a mean result of 0.841 among patients treated surgically and 0.819 among those treated conservatively at 1 year follow-up, thus favoring surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>The surgical treatment of proximal humerus fractures is highly efficient in terms of patient autonomy and capacity for DLA. In our study, neurological disorders were the main consideration in the recovery of previous capacity for DLA. The indication for surgery should only be adopted with precaution, as patients may not regain their prior capacity for DLA and the mortality rate may increase. Calvo et al. conducted a study of proximal humerus fractures treated conservatively among a sample population of Spanish patients analogous to ours in which 32.6% suffered depression or anxiety after the intervention.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>The majority of patients with proximal humerus fractures treated surgically in the present study (79.5%) regained their previous capacity for DLA and were able to live at their home. These data differ from those obtained with other types of fractures, like hip fractures, in which only 55% of patients with stable pertrochanteric hip fractures treated surgically regained the capacity to walk after the fracture and only 66% regained their level of capacity for DLA prior to the fracture, thus indicating that a severe decline can be expected after hip fractures.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>The type of fracture does not influence the capacity for DLA. However, the treatment applied significantly influences the level of autonomy of patients. A greater deterioration for DLA was observed among patients treated surgically through hemiarthroplasty, and only 50% of them were fully independent. This result agrees with the expected functional results in hemiarthroplasties for proximal humerus fractures. In a series of hemiarthroplasties in comminuted fractures of the proximal humerus, Grönhagen et al. found that only 25 out 46 patients examined (54%) considered the function of the intervened shoulder to be satisfactory. They observed that neurological disorders also had a significant effect on DLA, and only 53.8% of patients with prior neurological disorders regained a full capacity for DLA after the intervention.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Calvo et al. found that, at 6 months after the fracture, 43.5% of patients reported difficulties for personal hygiene and 56.5% for normal activities of daily life, with only 13% of them being fully dependent.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Although it is widely recognized that proximal humerus fractures are osteoporotic and can be associated to subsequent additional fractures,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> the data obtained in the present study suggest that osteoporosis is underdiagnosed in the population selected, since only 11.3% of patients had been previously diagnosed and treated for osteoporosis prior to the proximal humeral fracture and up to 24% of our patients presented additional fractures during follow-up. Calvo observed that only 35.8% of patients who had suffered a fracture of the proximal humerus treated conservatively had been previously diagnosed with osteoporosis.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Proximal humerus fractures still represent a challenge for decision making and treatment. Aspects like morbidity and mortality, the possibility of regaining capacity for DLA and osteoporosis must be taken into consideration, along with the type of fracture and techniques, in order to offer the best possible treatment option.Study limitationsThis was a retrospective study with a small sample. It would also require a validated test for DLA.Level of evidenceLevel of evidence IV.Ethical responsibilitiesProtection of people and animalsThe authors declare that this investigation did not require experiments on humans or animals.Confidentiality of dataThe authors declare that this work does not reflect any patient data.Right to privacy and informed consentThe authors declare that this work does not reflect any patient data.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres351572" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec333111" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres351573" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec333112" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0025" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Study limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-26" "fechaAceptado" => "2014-02-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec333111" "palabras" => array:4 [ 0 => "Morbidity" 1 => "Fracture" 2 => "Humerus" 3 => "Osteoporosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec333112" "palabras" => array:4 [ 0 => "Morbilidad" 1 => "Fractura" 2 => "Húmero proximal" 3 => "Osteoporosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundThe aim of the present study is to analyze the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. MethodsA retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2–12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student's t test was used for statistical analysis. ResultsA total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used.Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. ConclusionsThere was a mortality of 18.6% among patients with surgically treated proximal humerus fractures.The majority of surgically treated patients were fully independent for DLA at long-term follow-up." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl objetivo de este estudio es analizar los factores que se correlacionan con la mortalidad y la capacidad para realizar actividades de la vida diaria (AVD) en las fracturas de húmero proximal tratadas quirúrgicamente. MétodosSe estudiaron retrospectivamente a 94 pacientes con fractura de húmero proximal intervenidas quirúrgicamente con un seguimiento medio de 8 años (2-12 años). De la muestra, se estudió el tipo de fractura, el tratamiento aplicado y sus comorbilidades. Se correlacionan los parámetros con la mortalidad y el nivel de las actividades de la vida diaria. ResultadosSe localizaron a 72 pacientes, de los cuales el 18,6% habían fallecido. Un 85,4% de los pacientes presentan comorbilidades. El 79,5% de los pacientes eran totalmente independientes para las actividades de la vida diaria. No encontramos correlación entre la mortalidad, el tipo de fractura y el tratamiento aplicado.No se encontró relación significativa entre las AVD y las comorbilidades con el tipo de fractura, pero sí que se encontró una reducción significativa de la función de las actividades de la vida diaria en pacientes tratados con hemiartroplastia y en pacientes con trastornos neurológicos. ConclusionesEncontramos una mortalidad del 18,6% en los pacientes con fractura de húmero proximal tratada quirúrgicamente.La mayoría de los pacientes intervenidos son totalmente independientes para las actividades de la vida diaria, con un seguimiento a largo plazo." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Isart A, Sánchez JF, Santana F, Puig L, Cáceres E, Torrens C. Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente. Rev Esp Cir Ortop Traumatol. 2014;58:223–228." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1076 "Ancho" => 1315 "Tamanyo" => 49295 ] ] "descripcion" => array:1 [ "en" => "Distribution of patients." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "If 3 points or >: apt (independent for DLA).If <3 points: not apt (dependent for DLA)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Can the patient shower without help? Yes=1/No=0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Can the patient get dressed without help? Yes=1/No=0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Can the patient eat without help? Yes=1/No=0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Can the patient move about without help? Yes=1/No= \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab525885.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Questionnaire on activities of daily life." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "COPD: chronic obstructive pulmonary disease.The mean follow-up period was 8 years (range: 2–12 years)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Venous insufficiency \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericarditis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute myocardial infarction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congestive heart failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vasculocerebral accident \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mitral valve prosthesis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Auriculoventricular block \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary emphysema \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asthma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic bronchitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lacunar strokes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parkinson \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Depression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dementia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemiplegia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schizophrenia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertigo syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metabolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Osteoporosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Irritable bowel syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab525887.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Types of comorbidities at the time of fracture." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Subvariable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mortality (% – P value)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">DLA (% – P value)</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.721 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.494 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of fracture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.362 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.612 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 parts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 parts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 parts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fracture-dislocation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of intervention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prosthesis/plate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.276 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.278 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.577 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.578 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.723 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.028<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metabolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.171 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.314 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Osteoporosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.672 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subsequent fractures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.531 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.052 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab525886.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Significant differences." ] ] ] "descripcion" => array:1 [ "en" => "Relationship between gender, type of fracture, type of intervention, comorbidity, osteoporosis, subsequent fractures and mortality/daily life activities (DLA)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of proximal humeral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. 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Adolphson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jse.2007.03.017" "Revista" => array:6 [ "tituloSerie" => "J Shoulder Elbow Surg" "fecha" => "2007" "volumen" => "16" "paginaInicial" => "766" "paginaFinal" => "773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17967549" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transosseous suture fixation of proximal humeral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Dimakopoulos" 1 => "A. Panagopoulos" 2 => "G. 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Original Article

Morbidity and mortality of surgically treated proximal humerus fractures

Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente

A. Isarta,

Corresponding author

isartanna@gmail.com

Corresponding author.

, J.F. Sánchezb, F. Santanab, L. Puigb, E. Cáceresa, C. Torrensa,b

a Servicio de Cirugía Ortopédica y Traumatología, Institut Universitari Dexeus (ICATME), Barcelona, Spain

b Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Barcelona, Spain

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Those who suffer fractures of the proximal humerus most often present subsequent osteoporotic fractures&#46; In spite of this knowledge&#44; scarce attention has been paid to the diagnosis and treatment of the underlying osteoporosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Proximal humerus fractures are associated to a higher mortality&#44; especially among males&#46; Nevertheless&#44; very few studies to date have analyzed the mortality and capacity to carry out daily life activities &#40;DLA&#41; among patients suffering proximal humerus fractures and undergoing surgical treatment&#44; compared to those suffering hip fractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;23</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of this study is to analyze the factors correlating mortality and the capacity to perform DLA among patients with proximal humerus fractures treated surgically&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective study after prospectively gathering data from 94 patients undergoing surgical treatment of proximal humerus fractures at our center&#44; 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as well as a computed tomography &#40;CT&#41; scan for correct classification&#46; Fractures were classified according to the Neer classification&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> resulting in the following distribution&#58; 33 fractures in 2 fragments &#40;17 fractures of the surgical neck&#44; 9 fractures of the anatomical neck&#44; 7 fractures of the greater tuberosity&#41;&#44; 44 fractures in 3 fragments &#40;40 fractures of the greater tuberosity&#44; 4 fractures of the lesser tuberosity&#41;&#44; 9 fractures in 4 fragments&#44; 2 fracture-dislocations in 2 fragments&#44; 2 fracture-dislocations in 3 fragments and 4 fracture-dislocations in 4 fragments&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patients studied underwent different surgical treatments depending on the type of fracture&#44; age and criteria of the surgeon&#46; Of these&#44; 40 were intervened through isolated transosseous sutures&#44; 27 through transosseous sutures associated to Ender nails&#44; 3 through placement of angular stability plates&#44; 22 through hemiarthroplasties and 2 through inverted prostheses&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients were reviewed in order to obtain data on&#58; &#40;a&#41; mortality&#44; &#40;b&#41; subsequent fractures&#44; &#40;c&#41; the level of satisfaction with the function of the affected shoulder &#40;stratified into 3 categories&#58; very satisfactory&#44; satisfactory and not satisfactory&#41; and d&#41; the level of dependence or independence for DLA &#40;assessed through 4 questions &#91;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#93; which established whether the patient was capable&#47;incapable of DLA&#44; with this variable being qualitative&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">We also reviewed comorbidities &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; 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3&#8211;10 years&#41; in the left shoulder group&#46; Only 1 case died during the first year after the intervention &#40;the patient had a history of mammary carcinoma&#41;&#44; for causes unrelated to the fracture of the proximal humerus&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The distribution of mortality according to the type of fracture was as follows&#58; 2 deaths among patients with fractures in 2 parts&#44; 5 among patients with fractures in 3 parts&#44; 3 among patients with fractures in 4 parts and 1 in a patient with a fracture-dislocation in 4 parts&#46; No statistically significant correlation between mortality and the type of fracture was observed &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;362&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We observed less deaths among patients treated with transosseous sutures &#40;3 patients&#41;&#44; whereas the number of deaths increased slightly among those treated by transosseous suture and Ender nails &#40;7 patients&#41;&#44; without reaching statistical significance &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;92&#41;&#46; The mode of treatment was not correlated with mortality &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;145&#41;&#46; We obtained a statistically significant correlation between age and the treatment applied&#44; with those patients treated by prosthesis&#44; transosseous sutures and Ender nails being older than the rest &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We found a greater number of comorbidities among deceased patients&#46; Respiratory disease was not present in any case of death&#44; whereas metabolic disease was present in 13 cases&#44; heart disorders in 4 and neurological disorders in 2 cases&#46; In general&#44; all deceased patients presented more than 1 comorbidity&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">There were 4 deaths among patients who were diagnosed with osteoporosis prior to the fracture &#40;all of them through bone densitometry&#41;&#46; All osteoporotic patients with no comorbidity were still alive at the time of the interview&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the level of dependence for DLA&#44; nearly all of the patients &#40;79&#46;5&#37;&#41; were totally independent for daily life activities at the end of the follow-up period&#46; We found no significant correlation between the type of fracture and autonomy for DLA &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;612&#41;&#46; We observed that the type of treatment had a significant influence on the final autonomy for DLA of the 35 patients treated with transosseous suture&#44; with 32&#47;35 &#40;91&#46;4&#37;&#41; being totally independent&#46; Of the 17 patients treated with transosseous sutures and Ender nails&#44; 13&#47;17 &#40;76&#46;5&#37;&#41; were independent&#44; whilst among those treated with an angular stability plate or shoulder prosthesis&#44; only 50&#37; were fully independent for DLA &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Out of the 13 patients with neurological disorders&#44; only 53&#46;8&#37; were autonomous for DLA&#46; Patients suffering Parkinson&#39;s disease and different types of dementia were already dependent before the intervention&#44; as well as 1 patient who had been previously diagnosed with M&#233;ni&#232;re syndrome&#44; 1 with essential tremor and 2 with depression who ceased to be independent for DLA after suffering the fracture and subsequent intervention&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A statistically significant correlation was found between neurological disorders and a lack of autonomy for DLA &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;028&#41;&#46; Conversely&#44; heart disease&#44; respiratory disease and metabolic disease did not worsen the capacity for DLA&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">No significant correlation was found in relation to capacity for DLA between patients diagnosed with osteoporosis at the time of the fracture or subsequently to the fracture &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;672&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In 18 patients &#40;24&#37;&#41; we found other fractures after the proximal humerus fracture&#44; including&#58; 9 fractures of the proximal end of the femur&#44; 4 vertebral fractures&#44; 5 fractures of the distal radius&#44; 2 clavicular fractures&#44; 1 bimalleolar ankle fracture&#44; 1 patellar fracture&#44; 1 fracture of the contralateral proximal humerus and 1 fracture in the metacarpus of the hand&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Only 61&#46;1&#37; of those who suffered associated fractures continued to be autonomous for activities of daily life&#46; Patients without additional fractures were significantly more autonomous for DLA than those who suffered other fractures &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Only 11&#46;3&#37; of patients had been previously diagnosed and treated for their osteoporosis before the proximal humeral fracture&#46; This condition did not significantly affect the type of fracture or the presence of additional fractures &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;283&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In total&#44; 59&#46;4&#37; of patients described the result obtained in their shoulder as very satisfactory&#44; 32&#46;8&#37; as satisfactory and 7&#46;8&#37; as unsatisfactory&#46; Satisfaction was significantly correlated with autonomy for DLA at the end of the follow-up period &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">The best treatment option for proximal humerus fractures has not yet been defined&#46; At the time of deciding on the treatment&#44; the surgeon must take into account the fact that patients treated by surgery have a high mortality rate&#44; especially those presenting comorbidities&#46; In the present study&#44; patients with surgically treated proximal humerus fractures who presented comorbidities seemed to have a higher mortality risk&#46; On the other hand&#44; the majority of surgically treated patients who remained alive at the end of the follow-up period remained autonomous and were able to live independently&#44; except for those with neurological comorbidities&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study of proximal humerus fractures treated surgically&#44; mortality during the first year was limited to 1 patient&#46; This lower mortality rate during the first year can be explained by the fact that patients eligible for surgery are generally those who are most suitable and do not present serious diseases&#46; Despite the fact that 85&#46;4&#37; of the patients included presented some comorbidity at the time of the fracture&#44; this did not significantly harm patients&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Mortality increased to 18&#46;6&#37; throughout the follow-up period &#40;with a mean duration of 8 years&#41;&#44; significantly higher than the mortality rate expected in a group of comparable age and gender in Spain&#44; according to the National Statistics Institute &#40;the combined rate of deaths among males and females at the age of 72 years was of 16&#46;67 per 1000 in 2012&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> We only found deaths in patients with comorbidity at the time of the fracture and with no correlation with the type of fracture or the treatment applied&#44; which means that special attention should be paid to comorbidities when facing the decision of applying surgical treatment to proximal humerus fractures&#44; although in our study we did not identify a significant relationship&#46; A study conducted on a sample French population found a mortality rate of 9&#46;1&#37; in patients with proximal humerus fractures and a mean follow-up period of 4 years&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Another work in the same line of analysis found a mortality rate of 0&#46;6&#37; after 1 year of having suffered a proximal humerus fracture treated conservatively&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The results obtained in this work indicate that the majority of patients who underwent surgery due to fractures of the proximal humerus and who were in good condition in terms of autonomy and capacity for DLA&#44; did not vary after the treatment&#46; When comparing quality of life through the HRQol test between elderly patients intervened due to fractures of the proximal humerus and those treated conservatively&#44; similar studies&#44; such as that by Fjalestad et al&#46; obtained a mean result of 0&#46;841 among patients treated surgically and 0&#46;819 among those treated conservatively at 1 year follow-up&#44; thus favoring surgical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The surgical treatment of proximal humerus fractures is highly efficient in terms of patient autonomy and capacity for DLA&#46; In our study&#44; neurological disorders were the main consideration in the recovery of previous capacity for DLA&#46; The indication for surgery should only be adopted with precaution&#44; as patients may not regain their prior capacity for DLA and the mortality rate may increase&#46; Calvo et al&#46; conducted a study of proximal humerus fractures treated conservatively among a sample population of Spanish patients analogous to ours in which 32&#46;6&#37; suffered depression or anxiety after the intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The majority of patients with proximal humerus fractures treated surgically in the present study &#40;79&#46;5&#37;&#41; regained their previous capacity for DLA and were able to live at their home&#46; These data differ from those obtained with other types of fractures&#44; like hip fractures&#44; in which only 55&#37; of patients with stable pertrochanteric hip fractures treated surgically regained the capacity to walk after the fracture and only 66&#37; regained their level of capacity for DLA prior to the fracture&#44; thus indicating that a severe decline can be expected after hip fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The type of fracture does not influence the capacity for DLA&#46; However&#44; the treatment applied significantly influences the level of autonomy of patients&#46; A greater deterioration for DLA was observed among patients treated surgically through hemiarthroplasty&#44; and only 50&#37; of them were fully independent&#46; This result agrees with the expected functional results in hemiarthroplasties for proximal humerus fractures&#46; In a series of hemiarthroplasties in comminuted fractures of the proximal humerus&#44; Gr&#246;nhagen et al&#46; found that only 25 out 46 patients examined &#40;54&#37;&#41; considered the function of the intervened shoulder to be satisfactory&#46; They observed that neurological disorders also had a significant effect on DLA&#44; and only 53&#46;8&#37; of patients with prior neurological disorders regained a full capacity for DLA after the intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Calvo et al&#46; found that&#44; at 6 months after the fracture&#44; 43&#46;5&#37; of patients reported difficulties for personal hygiene and 56&#46;5&#37; for normal activities of daily life&#44; with only 13&#37; of them being fully dependent&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Although it is widely recognized that proximal humerus fractures are osteoporotic and can be associated to subsequent additional fractures&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> the data obtained in the present study suggest that osteoporosis is underdiagnosed in the population selected&#44; since only 11&#46;3&#37; of patients had been previously diagnosed and treated for osteoporosis prior to the proximal humeral fracture and up to 24&#37; of our patients presented additional fractures during follow-up&#46; Calvo observed that only 35&#46;8&#37; of patients who had suffered a fracture of the proximal humerus treated conservatively had been previously diagnosed with osteoporosis&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Proximal humerus fractures still represent a challenge for decision making and treatment&#46; Aspects like morbidity and mortality&#44; the possibility of regaining capacity for DLA and osteoporosis must be taken into consideration&#44; along with the type of fracture and techniques&#44; in order to offer the best possible treatment option&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study limitations</span><p id="par0185" class="elsevierStylePara elsevierViewall">This was a retrospective study with a small sample&#46; It would also require a validated test for DLA&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Level of evidence</span><p id="par0190" class="elsevierStylePara elsevierViewall">Level of evidence IV&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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              "titulo" => "Right to privacy and informed consent"
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    "fechaRecibido" => "2013-03-26"
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            0 => "Morbidity"
            1 => "Fracture"
            2 => "Humerus"
            3 => "Osteoporosis"
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          "palabras" => array:4 [
            0 => "Morbilidad"
            1 => "Fractura"
            2 => "H&#250;mero proximal"
            3 => "Osteoporosis"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The aim of the present study is to analyze the factors associated with mortality and the capacity to perform daily life activities &#40;DLA&#41; in patients with surgically treated proximal humeral fractures&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture&#44; with a mean follow-up of 8 years &#40;2&#8211;12 years&#41;&#46; A correlation analysis was performed to determine the relationship between the type of fracture&#44; surgical technique&#44; comorbidities and mortality and DLA&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span> test was used for statistical analysis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 72 patients were identified&#44; 18&#46;6&#37; of them died during follow-up&#44; all diagnosed with some comorbidity&#46; There was no correlation between mortality&#44; type of fracture or the technique used&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Most of the patients &#40;85&#46;4&#37;&#41; had comorbidities&#44; and 79&#46;5&#37; were completely independent for DLA&#46; Although there was no relationship with the type of fracture&#44; there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty&#44; and in patients with neurological disorders&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">There was a mortality of 18&#46;6&#37; among patients with surgically treated proximal humerus fractures&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The majority of surgically treated patients were fully independent for DLA at long-term follow-up&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es analizar los factores que se correlacionan con la mortalidad y la capacidad para realizar actividades de la vida diaria &#40;AVD&#41; en las fracturas de h&#250;mero proximal tratadas quir&#250;rgicamente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron retrospectivamente a 94 pacientes con fractura de h&#250;mero proximal intervenidas quir&#250;rgicamente con un seguimiento medio de 8 a&#241;os &#40;2-12 a&#241;os&#41;&#46; De la muestra&#44; se estudi&#243; el tipo de fractura&#44; el tratamiento aplicado y sus comorbilidades&#46; Se correlacionan los par&#225;metros con la mortalidad y el nivel de las actividades de la vida diaria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se localizaron a 72 pacientes&#44; de los cuales el 18&#44;6&#37; hab&#237;an fallecido&#46; Un 85&#44;4&#37; de los pacientes presentan comorbilidades&#46; El 79&#44;5&#37; de los pacientes eran totalmente independientes para las actividades de la vida diaria&#46; No encontramos correlaci&#243;n entre la mortalidad&#44; el tipo de fractura y el tratamiento aplicado&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No se encontr&#243; relaci&#243;n significativa entre las AVD y las comorbilidades con el tipo de fractura&#44; pero s&#237; que se encontr&#243; una reducci&#243;n significativa de la funci&#243;n de las actividades de la vida diaria en pacientes tratados con hemiartroplastia y en pacientes con trastornos neurol&#243;gicos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Encontramos una mortalidad del 18&#44;6&#37; en los pacientes con fractura de h&#250;mero proximal tratada quir&#250;rgicamente&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los pacientes intervenidos son totalmente independientes para las actividades de la vida diaria&#44; con un seguimiento a largo plazo&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Isart A&#44; S&#225;nchez JF&#44; Santana F&#44; Puig L&#44; C&#225;ceres E&#44; Torrens C&#46; Morbimortalidad en fracturas de h&#250;mero proximal tratadas quir&#250;rgicamente&#46; Rev Esp Cir Ortop Traumatol&#46; 2014&#59;58&#58;223&#8211;228&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">If 3 points or &#62;&#58; apt &#40;independent for DLA&#41;&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">If &#60;3 points&#58; not apt &#40;dependent for DLA&#41;&#46;</p>"
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                  \t\t\t\t">1&#46; Can the patient shower without help&#63; Yes<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#47;No<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46; Can the patient move about without help&#63; Yes<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#47;No<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab525885.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Questionnaire on activities of daily life&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">COPD&#58; chronic obstructive pulmonary disease&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The mean follow-up period was 8 years &#40;range&#58; 2&#8211;12 years&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Heart</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venous insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute myocardial infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congestive heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasculocerebral accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mitral valve prosthesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Auriculoventricular block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Respiratory</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulmonary emphysema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic bronchitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neurological</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lacunar strokes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parkinson&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemiplegia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schizophrenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertigo syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Metabolic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Irritable bowel syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab525887.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Types of comorbidities at the time of fracture&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Subvariable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mortality &#40;&#37; &#8211; <span class="elsevierStyleItalic">P</span> value&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DLA &#40;&#37; &#8211; <span class="elsevierStyleItalic">P</span> value&#41;</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;721&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;494&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Ender&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Prosthesis&#47;plate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Cardiac&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Respiratory&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Relationship between gender&#44; type of fracture&#44; type of intervention&#44; comorbidity&#44; osteoporosis&#44; subsequent fractures and mortality&#47;daily life activities &#40;DLA&#41;&#46;</p>"
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                        "tituloSerie" => "J Bone Joint Surg Br"
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Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2014.06.008

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Year/Month	Html	Pdf	Total

2024 November	5	0	5
2024 October	14	8	22
2024 September	27	8	35
2024 August	17	8	25
2024 July	17	3	20
2024 June	16	2	18
2024 May	15	6	21
2024 April	18	1	19
2024 March	20	5	25
2024 February	16	7	23
2024 January	24	8	32
2023 December	28	9	37
2023 November	16	4	20
2023 October	27	6	33
2023 September	7	3	10
2023 August	7	6	13
2023 July	10	4	14
2023 June	17	2	19
2023 May	40	6	46
2023 April	35	5	40
2023 March	26	0	26
2023 February	5	4	9
2023 January	10	9	19
2022 December	7	7	14
2022 November	14	7	21
2022 October	13	5	18
2022 September	12	2	14
2022 August	13	9	22
2022 July	7	7	14
2022 June	7	5	12
2022 May	11	8	19
2022 April	18	11	29
2022 March	13	6	19
2022 February	7	5	12
2022 January	10	5	15
2021 December	15	8	23
2021 November	10	6	16
2021 October	9	16	25
2021 September	17	15	32
2021 August	10	3	13
2021 July	6	7	13
2021 June	14	8	22
2021 May	14	9	23
2021 April	15	15	30
2021 March	10	5	15
2021 February	10	13	23
2021 January	7	4	11
2020 December	1	0	1
2018 February	10	0	10
2018 January	10	1	11
2017 December	6	1	7
2017 November	6	4	10
2017 October	15	1	16
2017 September	4	1	5
2017 August	14	7	21
2017 July	13	1	14
2017 June	14	4	18
2017 May	18	5	23
2017 April	15	12	27
2017 March	23	10	33
2017 February	17	0	17
2017 January	14	1	15
2016 December	11	4	15
2016 November	5	7	12
2016 October	14	3	17
2016 September	6	1	7
2016 August	6	5	11
2016 July	4	1	5
2016 May	0	2	2
2014 November	0	2	2
2014 September	0	1	1
2014 July	1	2	3

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