Proximal and Distal Femoral Fracture. A Longitudinal Retrospective Survival Analysis.

BACKGROUND

Osteoporotic fractures represent a major public health problem, particularly in older adults. Distal femur fractures, although less frequent, have also been associated with substantial mortality, with rates approaching those of hip fractures. However, direct comparisons between both entities remain limited and heterogeneous, and it is unclear whether distal femur fractures carry a comparable prognostic burden.

METHODS

We conducted a retrospective observational cohort study including surgically treated patients aged ≥65 years with proximal or distal femoral fractures between 2013 and 2019. Distal fracture cases were compared with a proximal femoral fracture cohort. Cases were identified using ICD codes and validated through clinical record review. The primary outcome was all-cause mortality at 30, 90, and 365 days after surgery. Survival was analyzed using Kaplan-Meier curves, compared with the log-rank test. Cox proportional hazards models were used to assess the association between fracture type and mortality, adjusting for relevant clinical variables.

RESULTS

A total 234 proximal and 74 distal femoral fractures patients were included. One-year mortality was similar between groups (27.4% vs. 35.6%, p=0.176). However, mortality was significantly higher in distal fractures at 30 days (16.2% vs. 7.7%, p = 0.031) and 90 days (24.3% vs. 14.1%, p = 0.039). Kaplan-Meier analysis showed significant differences at 30 and 90 days but not at 365 days. In multivariable Cox regression, fracture type was not independently associated with mortality, while rurality was associated with lower mortality.

CONCLUSION

Although distal femoral fractures were associated with higher short- and mid-term mortality, fracture type was not an independent predictor of mortality after multivariable adjustment. Rurality emerged as an independent predictor of survival, warranting further investigation. These findings suggest that distal femur fractures may require a similar level of clinical attention.