Distal femur fractures in the elderly: Does surgical delay affect morbidity and mortality?

PURPOSE: Distal femur fractures present a pertinent orthopaedic issue due to its increasing incidence in the elderly, being the second most common fragility fracture of the femur after hip fractures. Whilst the benefits of early surgery are well established in hip fractures, there is less consensus on the timing of surgery for distal femur fractures. This study aims to characterise the outcomes of surgically treated distal femur fractures in the elderly in terms of morbidity and mortality and evaluate if these are affected by surgical delay for > 48 h.

METHODS

A retrospective study of all surgically treated distal femur fractures at a single institution from 2007 to 2016 was performed. Patients of age ≥ 60 and a minimum of 1 year follow up were included. Data on demographics, morbidity and mortality were collected and analysed.

RESULTS

79 patients with a mean age of 75.4 ± 10.4 years were included. 1-year mortality was 8.9%, with ASA grade 4 the only independent predictor, p = 0.039. Delay in surgery > 48 h did not influence mortality rates. Thirty-two (40.5%) patients developed at least 1 medical complication and 17 (21.5%) patients had venous thromboembolism (VTE). Infection, non-union and re-operation rates were 7.6%, 5.1% and 13.9% respectively. The number of independent ambulators at final follow up decreased from 45 (57.0%) to 9 (11.4%) patients, p < 0.001.

CONCLUSION

Distal femur fractures in the elderly have a 1-year mortality rate of 8.9% in our study. Early surgery within 48 h did not confer any survival benefit, with ASA 4 status being the only independent predictor for mortality. Whilst the mortality rate was relatively lower compared to other studies, our patients experienced notable morbidities and had significant decline in ambulatory status at final follow up. Level of evidence III.