Mortality after distal femur fractures in elderly patients.
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.


OBJECTIVE
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.


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.


METHODS
Level II, prognostic study. See the guidelines online for a complete description of evidence.
Streubel
Philipp N
PN
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.streubel@gmail.com
Ricci
William M
WM
Wong
Ambrose
A
Gardner
Michael J
MJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005264:Femoral Fractures / Q000401:mortality* / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality*; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008923:Missouri; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome