Intramedullary stabilization of distal-third femur fractures in octogenarians

Management of distal-third femoral fractures is challenging, especially in the elderly population, where the associated complication rate has been reported to be as high as 40%. This study reviews the techniques and safety of intramedullary stabilization for displaced and unstable fractures involving the distal third of the femur in patients who were at least 80 years old, with the use of Ender nails. A retrospective study of 12 patients with 14 femur fractures underwent closed fixation of their fracture(s) with Ender nails performed within 24 hours of the injury. There were 10 females and 2 males, whose average age was 88 years (range, 82-103 years). The average length of follow-up was 3 years. Twelve fractures (86%) healed uneventfully. There were two nonunions (14%) with no other major or minor complications. No patients were lost to follow-up evaluation. All patients eventually returned to their preinjury level of function. This technique is particularly applicable to elderly patients with severe osteopenia and preexisting medical problems, as it minimizes blood loss and other associated complications, while providing stability for immediate mobilization.