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Comparative Study
. 2011 Apr;469(4):1188-96.
doi: 10.1007/s11999-010-1530-2. Epub 2010 Sep 10.

Mortality after distal femur fractures in elderly patients

Philipp N Streubel  1 , William M Ricci, Ambrose Wong, Michael J Gardner
Affiliations
Comparative Study

Mortality after distal femur fractures in elderly patients

Philipp N Streubel et al. Clin Orthop Relat Res. 2011 Apr.

Abstract

Background: Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear.

Questions/purposes: We evaluated the mortality of elderly patients after distal femur fractures; determined predictors for mortality; analyzed the effect of surgical delay; and compared survivorship of elderly patients with distal femur fractures with subjects in a matched hip fracture group.

Patients and methods: We included 92 consecutive patients older than 60 years with low-energy supracondylar femur fractures treated between 1999 and 2009. Patient, fracture, and treatment characteristics were extracted from operative records, charts, and radiographs. Data regarding mortality were obtained from the Social Security Death Index.

Results: Age-adjusted Charlson Comorbidity Index and a previous TKA were independent predictors for decreased survival. Congestive heart failure, dementia, renal disease, and history of malignant tumor led to shorter survival times. Patients who underwent surgery more than 4 days versus 48 hours after admission had greater 6-month and 1-year mortality risks. No differences in mortality were found comparing patients with native distal femur fractures with patients in a hip fracture control group.

Conclusions: Periprosthetic fractures and fractures in patients with dementia, heart failure, advanced renal disease, and metastasis lead to reduced survival. The age-adjusted Charlson Comorbidity Index may serve as a useful tool to predict survival after distal femur fractures. Surgical delay greater than 4 days increases the 6-month and 1-year mortality risks. Mortality after native fractures of the distal femur in the geriatric population is high and similar to mortality after hip fractures.

Level of evidence: Level II, prognostic study. See the guidelines online for a complete description of evidence.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves show survivorship of distal femur fractures in the presence and absence of a TKA. The vertical lines represent censored data.
Fig. 2
Fig. 2
Kaplan-Meier survival curves show survivorship of distal femur fractures according to age-adjusted CCI. The vertical lines represent censored data.
Fig. 3
Fig. 3
Kaplan-Meier survival curves show survivorship of nonperiprosthetic distal femur and hip fractures. The vertical lines represent censored data.
See this image and copyright information in PMC

References

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