Geriatric distal femur fracture: Are we underestimating the rate of local and systemic complications?

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• 作者：Gele B. Moloney ^{gelemoloney@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Tiffany Pan ^{pantj@upmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Carola F. Van Eck ^{vaneckcf@upmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Devan Patel ^{Patel.Devan@medstudent.pitt.edu" class="auth_mail" title="E-mail the corresponding author} ; Ivan Tarkin ; ^{tarkinis@upmc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Geriatric distal femur fracture ; Distal femur nonunion ; Mortality ; Complications ; Periprosthetic distal femur fracture ; Geriatric fracture
• 刊名：Injury
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：47
• 期：8
• 页码：1732-1736
• 全文大小：367 K

文摘

Low energy distal femur fractures often occur in a fragile elderly population that is prone to local and systemic complications following operative treatment of extremity fractures. The nonunion rate and early complication rate following laterally based locked plating in this specific fracture are not well described.

Methods

We conducted a retrospective cohort study conducted at three affiliated tertiary care hospitals to evaluate nonunion, early post operative complications, discharge disposition, length of stay, and mortality in patients over 60 years old undergoing laterally based locked plating of a low energy distal femur fracture.

Results

Forty-four out of 176 patients were deceased at one year (25%). Predictors of one year mortality included older age, higher Charlson Comorbidity Index (CCI), and delay to surgery greater than 2 days (p < 0.001). Of 99 patients alive and with follow up at one year, 24 (24%) developed a nonunion and 21 of 24 required nonunion surgery. Development of a surgical site infection was statistically significantly correlated with development of nonunion. Age and CCI did not predict development of nonunion. Average length of stay was 10 days and 82% of patients were discharged to a skilled nursing facility. Thirty eight percent of patients experienced at least one postoperative systemic complication.

Conclusions

Laterally based locked plating of the low energy geriatric distal femur fracture is most often followed by a tumultuous post-operative course with a high rate of local and systemic complications including death, nonunion, and extended hospital stays.

Level of evidence

Level III prognostic.