Geriatric distal femoral fractures: A retrospective study of 30 day mortality

Distal femoral fractures have many of the same challenges as hip fractures, but there has been limited research into outcomes following these. The aim of this study was to assess 30 day mortality following distal femoral fractures in comparison to hip fractures presenting to a single institution Secondary outcomes included risk factors for mortality, post-operative complications and union.

A retrospective case series of all distal femoral fragility fractures in patients over 65, and hip fractures over a 5 year period at a single institution.

88 distal femoral fractures and 2837 hip fractures fulfilled the inclusion criteria. In the distal femoral fractures there were 80 females and 8 males with a mean age of 82.4 (range 65-103). The mean age of the hip fractures was 83.7 (range 65-106) and there were 2066 females and 771 males. The overall 30 day mortality for hip fractures was 7.7% and was 9.1% for distal femoral fractures. The risk ratio was 1.1777(95% CI 0.6009-2.3080) (p = 0.6338). There was no significant difference in 30 day mortality between the two fracture types. Of the 88 distal femoral fractures 75 (85.2%) underwent open reduction internal fixation, 5 (5.7%) intramedullary nail and 8 (9.1%) conservative treatment. 11.4% suffered a medical complication. 9.1% patients required at least 1 further surgical procedure. The union rate was 94.3%. The 1 year mortality was 34.1%.

There is no significant difference in 30 day mortality between distal femoral and hip fractures. Distal femoral fractures occur in a complex group of patients that is similar to hip fractures. They have high mortality and complication rates.