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Published on: June 6, 2025
Perioperative Considerations When Treating Isolated Periprosthetic Distal Femur Fractures
Michael S Reich1, Mindy Duong1, Mary A Breslin1
1Study performed at MetroHealth Medical Center, Department of Orthopaedic Surgery, affiliated with Case Western Reserve University,2500 MetroHealth Drive, Cleveland, OH 44109, USA.
Insights
Elderly patients with periprosthetic distal femur (PPDF) fractures often face complex hospital stays. This study identifies risk factors for poor outcomes in these frail individuals undergoing surgery.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Geriatric Medicine
Background:
- Periprosthetic distal femur (PPDF) fractures commonly affect frail, elderly individuals, often due to low-energy mechanisms.
- These patients are frequently ill-suited to the physiological stress of trauma and surgical intervention.
- Understanding the perioperative course and outcomes is crucial for this vulnerable population.
Purpose of the Study:
- To describe the perioperative and early hospital course of patients with PPDF fractures.
- To identify risk factors associated with adverse outcomes in this patient group.
- To inform strategies for optimizing treatment and care.
Main Methods:
- A consecutive series of patients with isolated PPDF fractures treated operatively between 2005 and 2015 was reviewed.
- Perioperative records were analyzed to capture patient demographics, surgical details, and complications.
- Complications assessed included wound issues, cardiac events, pneumonia, thromboembolism, UTIs, sepsis, multiple organ failure, death, and 90-day readmissions.
Main Results:
- Thirty-nine patients (mean age 75.1 years, 87.2% female) underwent operative treatment, predominantly open reduction and internal fixation.
- The average American Society of Anesthesiologists score was 3.0, indicating significant comorbidity.
- Complications occurred in 17.9% of patients, with cardiac events (12.8%) and mortality (5.1%) noted. ICU admission correlated with longer length of stay (LOS).
Conclusions:
- Patients with PPDF fractures commonly present with significant medical comorbidities.
- A complicated or prolonged hospital course is a frequent occurrence.
- Further research is warranted to optimize the management of PPDF fractures in the elderly.
Background:
Periprosthetic distal femur (PPDF) fractures occur most frequently via low energy mechanisms in elderly patients. This population is often frail and ill-suited to the physiologic burden of trauma and surgery. Here, we describe the perioperative and early hospital course for patients with PPDF fractures, and identify risk factors for poor outcomes.
Methods:
Consecutive patients with isolated PPDF fractures from 2005 - 2015 were treated operatively at a Level I trauma center. Perioperative records were reviewed. Complications included wound complications, cardiac complications, pneumonia, thromboembolic events, urinary tract infections (UTIs), sepsis, multiple organ failure, death, and 90-day readmissions.
Results:
Thirty-nine patients were treated operatively for isolated PPDF fractures. Mean age was 75.1 years old, 87.2% were women, and 92.3% occurred after falls from standing. Average American Society of Anesthesiologists score was 3.0. Thirty-six patients underwent open reduction and internal fixation with a mean operative time of 108 minutes. Excluding outliers, mean LOS was 4.6 days. Patients admitted to the ICU had longer LOS (p=0.03). Complications occurred in 17.9% of patients, including cardiac events (12.8%) and (5.1%) deaths.
Conclusions:
Patients with PPDF fractures frequently have underlying medical comorbidities. A complicated and/or protracted hospital course is not uncommon. Further study to optimize treatment appears warranted. Level of evidence: Prognostic, level 4.
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