Upper Extremity Fractures in Older Medicolegal Patients: Radiologic Characteristics and Factors Associated with Permanent Functional Impairment

Background/Objectives: Upper extremity fractures in older adults may cause lasting disability, but radiologic characteristics associated with permanent functional impairment in medicolegal populations remain unclear. We described these injuries and examined associated factors. Methods: Of the 94 initially identified patients, seven with unavailable follow-up examination records were excluded. This single-center retrospective cohort included 87 medicolegal patients aged ≥65 years with 104 radiographically confirmed upper extremity fractures evaluated between 2015 and 2024. The outcome was permanent functional impairment documented in a definitive medicolegal report after clinically appropriate follow-up. An exploratory, clinically selected logistic regression model included age, multiple fractures, displacement, and intra-articular extension. Results: Median age was 70 years, 70.1% were men, and interpersonal violence was the most frequent mechanism (51.7%). Permanent functional impairment was identified in 35 patients (40.2%; 95% CI, 30.6–50.7). Multiple upper extremity fractures (aOR, 3.79; 95% CI, 1.01–14.25), at least one displaced fracture (aOR, 4.52; 95% CI, 1.30–15.73), and at least one intra-articular fracture (aOR, 3.94; 95% CI, 1.13–13.77) were associated with impairment in the adjusted model; no statistically significant association was detected for age. Conclusions: Fracture burden and morphology were associated with permanent functional impairment; an age association was not detected in this relatively small, age-concentrated cohort. Standardized reporting of fracture number, displacement, and intra-articular extension may support long-term follow-up and medicolegal evaluation.