Lower mortality following surgical management for distal femur fractures: A cohort study

Abstract

Introduction Geriatric distal femur fractures pose a difficult problem for orthopaedic surgeons with an aging population. The present study aims to report mortality rates following distal femur fractures from a geriatric population over 60 years old, with a primary emphasis on determining whether surgical management differentially affects mortality rate as compared to conservative management. Methods Patients over 60 years old with distal femur fractures for patients admitted into the New Territories West Cluster from 2012 to 2020 were identified in this retrospective cohort study. Patient demographics, comorbidities, and management characteristics were examined and analyzed. Kaplan-Meier survival analysis was done to delineate differences in mortality rates between surgical and conservative management. Further analysis was done for patients >80 years old using Kaplan-Meier survival analysis to delineate whether surgical intervention still affects the survival in this narrowed geriatric population. Subsequent multivariate cox regression was done to determine variables with significant effect on mortality in this age group. Results Of 168 patients, the 1-year mortality rate is 21.5%. The cumulative median survival time of the surgical group (5.98 years) versus the conservative group (2.32 years). Survival analysis on patients >80 years old revealed age, management type, ambulatory status, place of residence, dementia, chronic pulmonary disease, or chronic kidney disease had statistically different median time of survival. In these patients, a reduction in death hazard by 47% (CI 0.28–1.01, p = 0.05) was seen in those with surgical management. On the other hand, patients with chronic obstructive pulmonary disease (COPD) and moderate chronic kidney disease (CKD) show an increased death hazard by 2.61 times (CI 1.23–5.53, p = 0.01) and 7.17 times (CI 1.47–34.86, p = 0.02), respectively. Conclusion Compared to conservative management, surgical management resulted in higher cumulative survival in geriatric patients with distal femur fractures. Unfavourable factors that may contribute to a lower cumulative survival includes history of COPD and CKD.