Surgical Treatment of Distal Femur Fractures in Geriatric Patients

Abstract

Introduction: The treatment of distal femur fractures in geriatric patients is challenging and has a high perioperative morbidity and mortality. Treatments have evolved significantly in the past decades. The aim of our study was to analyze local and systemic morbidity and mortality, as well as functional results in this frail cohort treated with distal femur locking plates. Materials and methods: In this single-institution case series, we retrospectively analyzed the data of patients aged 65 years and older with fractures of the distal femur between March 2013 and March 2018. All patients were operated with distal femur locking plates. Points of interest included perioperative morbidity, mortality, weight-bearing status, and care-dependency after hospital discharge. Results: We assessed 49 patients (median age: 86.5 years) with 52 distal femur fractures (AO type A 77%, type C 15%, type B 8%). A total of 30 (58%) periprosthetic fractures with 4 (8%) interimplant femur fractures were documented. The perioperative morbidity was 64%, and the 3-month and 1-year mortality rates were 29% and 35%, respectively. The local complication rate was 6% with no documented implant failure. Of the patients who were living at home before the surgery, 62% required long-term accommodation in residential or nursing homes after dicharge from the hospital or short-term rehabilitation. Conclusions: Geriatric patients with distal femur fractures face a high perioperative mortality. Osteosynthesis with distal femur locking plates is a reliable technique that can be used in various fracture patterns including periprosthetic and interimplant fractures.