The distal femur is defined as the distal 15 cm of the femur including the metaphyseal-diaphyseal junction, femoral condyles, and the articular surface of the knee (1, 2). The incidence of distal femoral fractures and periprosthetic distal femoral fractures have been reported to be 8.7 per 100,000 per year, and 2.4 per 100,000 per year respectively (1). There is especially a rapid, continuous increase in the incidence after the age of 60 years. As the population ages, the treatment of these fractures has correlated with poor outcomes as elderly patients often present with significant co-morbidities impacting their recovery and survival (1, 2).
There is currently no treatment algorithm regarding native and periprosthetic distal femoral fractures, however many cases are treated with internal fixation such as a locked plating system. A locked plating system can be used minimally invasive and with a bridging fixation for relative stability. The angular and axial stability of the locking plate seems to minimize the risk of complications (3)
Previous studies have reported data on patient outcomes after treatment of distal femur fractures with ORIF (open reduction and internal fixation) and prosthesis in the elderly.
Salazar et al. (4) found, in a systematic review of 30 studies, a failure rate (defined as complications requiring major re-operations) of 8.6% and 10.4% in the treatment of native distal femur fractures with ORIF and prosthesis respectively. In another systematic review of 56 studies, Wadwa et al. (5) reported a failure rate (complications requiring re-operations) of 15% and 14% in the treatment of periprosthetic distal fracture with ORIF and prosthesis respectively.
Studies investigating patient safety regarding mortality, LOS (length of hospital stay), and readmission have found varying outcomes.
The one-year mortality after a native distal femoral fracture treated with ORIF has been assessed to span over 2-37% versus 0-10% in treatment with a prosthesis (6-12). The one-year mortality after a periprosthetic distal femoral fracture treated with a locked lateral plating has been assessed to be 22% versus 10% in treatment with a prosthesis (13). Reported data on postoperative LOS is also varying. The LOS after a native distal femoral fracture treated with ORIF or prosthesis has been found to be approximately 7 days for both groups (6-12).
LOS of 5-15 days for periprosthetic fractures treated with ORIF and 6-27 days in treatment with a prosthesis have been reported (13-15). Data on readmission risk however is limited. In the following studies (13, 14) the readmission risk is found to vary between 28-56% in patients with periprosthetic distal femur fractures, treated with prosthesis while the readmission risk after surgical treatment for native fractures is yet to be assessed.
Hence, there is no consensus about the best way to treat distal femur fractures in different patient groups and data on patient safety and re-operation risk is still limited. The aim of this study is to report patient safety measured as risk of in-hospital complications, readmission, mortality as well as re-operation after treatment of distal femur fractures with ORIF (locking plate system).
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