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Mortality After Distal Femur Fractures in Elderly Patients

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Acknowledgments

We thank Angel Brandt for invaluable help in obtaining study approval and supporting data management.

Author information

Authors and Affiliations

  1. Orthopedic Trauma Service, Department of Orthopedics, Washington University School of Medicine/Barnes-Jewish Hospital, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO, 63110, USA

    Philipp N. Streubel MD, William M. Ricci MD, Ambrose Wong BS & Michael J. Gardner MD

Authors
  1. Philipp N. Streubel MD
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  2. William M. Ricci MD
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  3. Ambrose Wong BS
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  4. Michael J. Gardner MD
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Corresponding author

Correspondence to Philipp N. Streubel MD.

Additional information

One or more of the authors have received funding from an educational and research grant from Smith and Nephew (Memphis, TN) (PNS, WMR, AW, MJG), AO North America (Paoli, PA) (PNS, WMR, AW, MJG), Synthes, Inc (Paoli, PA) (PNS, WMR, AW, MJG), and Foundation of Orthopaedic Trauma (PNS, WMR, AW, MJG).

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Streubel, P.N., Ricci, W.M., Wong, A. et al. Mortality After Distal Femur Fractures in Elderly Patients. Clin Orthop Relat Res 469, 1188–1196 (2011). https://doi.org/10.1007/s11999-010-1530-2

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  • DOI: https://doi.org/10.1007/s11999-010-1530-2

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