title: Distal femoral fractures: The need to review the standard of care.
abstract: BACKGROUND
  Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres.
  
  
  METHODS
  105 patients aged 50 years or greater with a distal femoral fracture, presenting to four UK major trauma centres between October 2010 and September 2011 were identified. Data was collected using an adapted NHFD data collection tool via retrospective case note and radiograph review. Local ethics approval was obtained.
  
  
  RESULTS
  Mean age was 77 years (range 50-99), with 86% female. 95% of injuries were sustained from a low energy mechanism, and 72% were classified as either 33-A1 or 33-C1. The mean Parker mobility score and Barthel Independence Index were 5.37 (0-9) and 75.5 (0-100) respectively. Operative management was performed in 84%, and 86% had their surgery within 36 h. Three quarters were fixed with a peri-articuar locking plate. There was no consensus on post operative rehabilitation, but no excess of complications in the centres where weight bearing as tolerated was the standard. 45% were seen by an orthogeriatrician during their admission. Mean length of stay was 29 days. Mortality at 30 days, 6 months, and 1 year was 7%, 16% and 18% respectively.
  
  
  CONCLUSIONS
  This study demonstrates that the distal femoral and hip fracture populations are similar, and highlights the current disparity in their management. The metrics and standards of care currently applied to hip fractures should be applied to the treatment of distal femoral fractures. Optimal operative treatment and rehabilitation remains unclear, and is in need of further research.
authors.affiliation: Department of Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom. Electronic address: jrasmith@me.com.
authors.forename: James R A
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Department of Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom.
authors.forename: Ruth
authors.initials: R
authors.lastname: Halliday
authors.affiliation: Department of Orthopaedics, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Aquilina
authors.affiliation: Department of Orthopaedics, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, United Kingdom.
authors.forename: Rory J M
authors.initials: RJ
authors.lastname: Morrison
authors.affiliation: Department of Orthopaedics, Addenbrooks Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Grace C K
authors.initials: GC
authors.lastname: Yip
authors.affiliation: Department of Orthopaedics, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: McArthur
authors.affiliation: Department of Orthopaedics, Addenbrooks Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Hull
authors.affiliation: Department of Orthopaedics, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gray
authors.affiliation: Department of Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000534:rehabilitation* / Q000628:therapy; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D059039:Standard of Care / Q000706:statistics & numerical data*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: Distal femoral; Femur; Fracture; Supracondylar