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Frailty and Gait Characteristics of Patients with Fall On Outstretched Hand (FOOSH) Injuries: A Single-Center Retrospective Study
Eshan B Damle, BS
1, Sara Eppler, MPH
2, Brady T Evans, MD, MBA
3; Robin N Kamal, MD, MBA, MS
3(1)Stanford University School of Medicine, Stanford, CA, (2)Stanford University Department of Orthopaedic Surgery, Redwood City, CA, (3)Stanford University, Redwood City, CA
IntroductionGround-level falls are a leading cause of morbidity and mortality in adults over 65 years of age. There exists a gap in understanding the fall rates due to frailty or gait abnormalities in patients that have not been formally diagnosed with such conditions. We conducted this study to examine the frailty characteristics and impact of gait abnormalities in patients who sustained a fall on outstretched hand (FOOSH) injury.
MethodsWe conducted a retrospective chart review at a single academic institution, generating four cohorts based on whether patients with a hand injury had a fall (++-), gait abnormality (+-+), both (+++), or neither (+--) using data from 01/01/2023 to 01/01/2024 and searching for patients with ICD-10 codes corresponding to injuries to the wrist/hand/fingers, falls (FOOSH), and gait abnormalities.
We calculated the 11-item modified frailty index (mFI-11) score and performed analysis of covariance (ANCOVA), controlling for age, as well as post-hoc pairwise t-tests with Bonferroni correction to report the statistical significance (p-value) of the differences between age-adjusted mean mFI-11 scores.
ResultsOf 8,420 patients who had suffered a hand injury, patients who had a gait abnormality had higher raw and age-adjusted mean frailty scores than those who did not (with or without FOOSH), and patients who had fallen had higher frailty scores than those who had not (with or without a gait abnormality) (Table 1). Comparing cohorts, the largest effect on mean frailty scores was seen with a combined impact of positive gait abnormality and fall status, followed by the isolated effect of having a gait abnormality (Table 2). The mean mFI-11 score was highest in the fall + gait abnormality cohort.
ConclusionsOur results demonstrate that of patients with a hand injury, patients who sustained the hand injury as a result of a fall and had a gait abnormality were the most frail, even when adjusting for age, suggestive of a true relationship between gait abnormalities, fall risk, and frailty scores among patients with a hand injury. These findings may inform clinical practice by highlighting the potential value for screening for gait abnormalities in patients with upper extremity injuries.
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