The Epidemiology of Adult Distal Femoral Shaft Fractures in a Central London Major Trauma Centre Over Five Years

Abstract

Background: Distal femoral fractures account for 3-6% of adult femoral fractures and 0.4% of all fractures and are associated with significant morbidity and mortality rates. As countries develop inter-hospital trauma networks and adapt healthcare policy for an aging population there is growing importance for research within this field.

Methods: Hospital coding and registry records at the central London Major Trauma Center identified 219 patients with distal femoral shaft fractures that occurred between December 2010 and January 2016. CT-Scans were reviewed resulting in exclusion of 73 inappropriately coded, 10 pediatric and 12 periprosthetic cases. Demographics, mechanism of injury, AO/OTA fracture classification and management were analyzed for the remaining 124 patients with 125 fractures. Mann Whitney U and Chi Squared tests were used during analyses.

Results: The cases show bimodal distribution with younger patients being male (median age 65.6) compared to female (median age 71). Injury caused through high-energy mechanisms were more common in men (70.5%) whilst women sustained injuries mainly from low-energy mechanisms (82.7%) (p<0.0001). Majority of fractures were 33-A (52.0%) followed by 33-B (30.4%) and 33-C (17.6%). Ninety-two (73.6%) underwent operative management. The most common operation was locking plates (64.1%) followed by intramedullary nailing (19.6%).

Interpretation: The epidemiology of a rare fracture pattern with variable degrees of complexity is described. A significant correlation between biological sex and mechanism of injury was identified. The fixation technique favored was multidirectional locking plates. Technical requirements for fixation and low prevalence of 33-C fractures warrant consideration of locating treatment at centers with high caseloads and experience.

Keywords: Adult; Distal Femur; Epidemiology; Femoral Fractures; Trauma; Traumatic Knee Injuries.

Fig. (1)

Patient Selection.

Fig. (2)

Gender and Age at time of Injury.

Fig. (3)

Gross distribution of mechanism causing distal femoral fractures.

Fig. (4)

Distribution of Injury Pattern according to AO/OTA Classification System .

Fig. (5)

A graph displaying the length of inpatient stay censored at either death or discharge .

Fig. (6)

A graph demonstrating the different management options for treating distal femoral fractures.

Fig. (7)

Use of plain radiographs to determine fracture configuration, size of bony comminution and bone stock; Anteroposterior Radiograph.

Fig. (8)

Use of plain radiographs to determine fracture configuration, size of bony comminution and bone stock. Lateral Radiograph.

Fig. (9)

CT Scan in Sagittal Section showing a coronal plane fracture of distal femur (Hoffa Fracture).

Fig. (10)

Use of CT Scan to determine fracture configuration, size of bony comminution and bone stock; Coronal Section.

Fig. (11)

Use of CT Scan to determine fracture configuration, size of bony comminution and bone stock; Sagittal Section.

Fig. (12)

Use of CT Scan to determine fracture configuration, size of bony comminution and bone stock; Horizontal Section.

Fig. (13)

Use of multidirectional locking plate and multidirectional screws to achieve stable fixation; Anteroposterior Radiograph.

Fig. (14)

Use of multidirectional locking plate and multidirectional screws to achieve stable fixation; Lateral Radiograph.