Clinical Orthopaedics and Related Research®

, Volume 469, Issue 4, pp 1188–1196

Mortality After Distal Femur Fractures in Elderly Patients

  • Philipp N. Streubel
  • William M. Ricci
  • Ambrose Wong
  • Michael J. Gardner
Clinical Research

DOI: 10.1007/s11999-010-1530-2

Cite this article as:
Streubel, P.N., Ricci, W.M., Wong, A. et al. Clin Orthop Relat Res (2011) 469: 1188. doi:10.1007/s11999-010-1530-2

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.

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Philipp N. Streubel
    • 1
  • William M. Ricci
    • 1
  • Ambrose Wong
    • 1
  • Michael J. Gardner
    • 1
  1. 1.Orthopedic Trauma Service, Department of OrthopedicsWashington University School of Medicine/Barnes-Jewish HospitalSt LouisMOUSA