Comparable Outcomes Between Native and Periprosthetic Fractures of the Distal Femur

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Arthroplasty and aging populations are increasing, leading to more periprosthetic fractures.
• Limited data exists on clinical outcomes comparing periprosthetic fractures to native bone fractures.
• Distal femur fractures are a significant concern in orthopedic trauma.

Purpose of the Study:

• To compare clinical outcomes, including treatment, morbidity, and mortality, of periprosthetic distal femur fractures versus native distal femur fractures.
• To analyze differences in hospital resource utilization and patient disposition between the two fracture types.
• To provide data on the management and outcomes of AO/OTA type 33 distal femur fractures at a Level 1 trauma center.

Main Methods:

• Retrospective review of 526 adult AO/OTA type 33 distal femur fractures from 2009-2018.
• Matched 54 periprosthetic fractures with 54 native fractures by age and gender.
• Collected data on demographics, operative measures, length of stay, discharge disposition, and mortality; analyzed using McNemar's and paired t-tests.

Main Results:

• No significant differences were observed in mean operative time, estimated blood loss, length of stay, or discharge disposition between native and periprosthetic groups.
• Mortality rates were comparable between the native (6/54) and periprosthetic (8/54) fracture groups.
• Both native and periprosthetic fractures were predominantly managed with open reduction internal fixation using a locking plate.

Conclusions:

• Periprosthetic distal femur fractures and native distal femur fractures exhibit similar clinical outcomes regarding morbidity and mortality.
• Treatment strategies and hospital resource utilization were comparable between the two fracture types.
• AO/OTA type 33 distal femur fractures, whether native or periprosthetic, represent serious injuries with comparable outcomes at a Level 1 trauma center.