Mortality in fracture of the distal femoral bone (review)

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Distal femur fractures in the elderly can lead to the exacerbation of chronic diseases and fatal outcomes similar to those observed in femoral neck fractures in the same category of individuals. Thus, this study aimed to determine the factors influencing the mortality of patients with distal femur fractures based on the analysis of foreign studies and results of treated patients. Review of foreign literature was conducted using the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, and Cochrane among articles in English, Chinese, Italian, and Russian, as well as through the Web of Knowledge. We analyzed publications for the last 10 years. Evaluation of treated patients included patients aged >60 years with distal femoral fractures between 2021 and 2023. Analysis of the literature data showed that distal femur fractures are accompanied by high mortality in patients in the first years after injury (from 18% to 35%), commonly in elderly patients without surgical treatment (90%–100%), and the presence of several concomitant diseases accompanied by contractures of the femur, knee joint, and false joint and displacement or fracture of the metal retainer. Early surgical treatment (first 48 h) is an effective treatment method that significantly reduces mortality after distal femur fracture (by 2.8 times).

Full Text

Restricted Access

About the authors

Kymbatbek R. Shermatov

Domodedovo Hospital

Author for correspondence.
Email: shermatov84@gmail.com
ORCID iD: 0000-0003-3251-2185

MD, Cand. Sci. (Med.)

Russian Federation, Domodedovo

Mikhail V. Parshikov

Moscow State Medical University named after A.I. Evdokimova

Email: parshikovmikhail@gmail.com
ORCID iD: 0000-0003-4201-4577
SPIN-code: 5838-4366

MD, Dr. Sci. (Med.), professor

Russian Federation, Moscow

Kamal M. Medjidov

Domodedovo Hospital

Email: Medjidof@mail.ru
ORCID iD: 0000-0003-3967-3782
Russian Federation, Domodedovo

References

  1. Loosen A, Fritz Y, Dietrich M. Surgical Treatment of Distal Femur Fractures in Geriatric Patients. Geriatric Orthopaedic Surgery & Rehabilitation. 2019;10:2151459319860723. doi: 10.1177/2151459319860723
  2. Holzman MA, Hanus BD, Munz JW, O’Connor DP, Brinker MR. Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions. Clin Orthop Relat Res. 2016;474(6):1498–1505. doi: 10.1007/s11999-016-4709-3
  3. Merino-Rueda LR, Rubio-Sáez I, Mills S, et al. Mortality after distal femur fractures in the elderly. Injury. 2021;52(Suppl 4):S71–S75. doi: 10.1016/j.injury.2021.03.066
  4. Larsen P, Ceccotti AA, Elsoe R. High mortality following distal femur fractures: a cohort study including three hundred and two distal femur fractures. Int Orthop. 2020;44(1):173–7. doi: 10.1007/s00264-019-04343-9
  5. Wolf O, Mukka S, Ekelund J, Möller M, Hailer NP. How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register. Acta Orthop. 2021;92(1):40–46. doi: 10.1080/17453674.2020.1831236
  6. Kammerlander C, Riedmüller P, Gosch M, Zegg M, Kammerlander-Knauer U, Schmid R, Roth T. Functional outcome and mortality in geriatric distal femoral fractures. Injury. 2012;43(7):1096–1101. doi: 10.1016/j.injury.2012.02.014
  7. Moloney GB, Pan T, Van Eck CF, Patel D, Tarkin I. Geriatric Distal Femur Fracture: Are We Underestimating the Rate of Local and Systemic Complications? Injury. 2016;47(8):1732–6. doi: 10.1016/j.injury.2016.05.024
  8. Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality After Distal Femur Fractures in Elderly Patients. Clin Orthop Relat Res. 2011;469:1188–1196. doi: 10.1007/s11999-010-1530-2
  9. Jennison T, Divekar M. Geriatric distal femoral fractures: A retrospective study of 30 day mortality. Injury. 2018;50(2):444–447. doi: 10.1016/j.injury.2018.10.035
  10. Raichandani K, Agarwal S, Jain H, Bharwani N. Mortality profile after 2 years of hip fractures in elderly patients treated with early surgery. J Clin Orthop Trauma. 2021;18:1–5. doi: 10.1016/j.jcot.2021.04.009
  11. Forni S, Pieralli F, Sergi A, Lorini C, Bonaccorsi G, Vannucci A. Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients. Archives of Gerontology and Geriatrics. 2016;66:13–17. doi: 10.1016/j.archger.2016.04.014
  12. Anakwe E, Aitken SA, Khan LAK. Osteoporotic periprosthetic fractures of the femur in elderly patients: outcome after fixation with the LISS plate. Injury. 2008;39(10):1191–1197. doi: 10.1016/j.injury.2008.02.003
  13. Smith JRA, Halliday R, Aquilina AL, et al.; Collaborative — Orthopaedic Trauma Society (OTS). Distal femoral fractures: The need to review the standard of care. Injury. 2015;46(6):1084–1088. doi: 10.1016/j.injury.2015.02.016
  14. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma. 2011;25(Suppl 1):S8–S14. doi: 10.1097/BOT.0b013e3182070127
  15. Myers P, Laboe P, Johnson KJ, et al. Patient mortality in geriatric distal femur fractures. J Orthop Trauma. 2018;32(3):111–15. doi: 10.1097/BOT.0000000000001078
  16. Someswar D, Thejaswini K, Pranathi R, Ravikumar K. A study on various approaches of functional outcome of distal femur fractures. Int. J Derm. Surg. 2019;5(1):11–15. doi: 10.26452/ijds.v5i1.1385
  17. Hoellwarth JS, Fourman MS, Crossett L, et al. Equivalent mortality and complication rates following periprosthetic distal femur fractures managed with either lateral locked plating or a distal femoral replacement. Injury. 2017;49(2):392–397. doi: 10.1016/j.injury.2017.11.040
  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. doi: 10.1016/0021-9681(87)90171-8
  19. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51. doi: 10.1016/0895-4356(94)90129-5
  20. Nyholm AM, Palm H, Kallemose T, Troelsen A, Gromov K; DFDB collaborators. No association between surgical delay and mortality following distal femoral fractures: a study from the Danish Fracture Database Collaborators. Injury. 2017;48(12):2833–7. doi: 10.1016/j.injury.2017.10.022
  21. Hernefalk B, Brüggemann A, Mohammed J, Mukka S, Wolf O. Lower mortality in distal femoral fractures in the presence of a knee arthroplasty: an observational study on 2,725 fractures from the Swedish Fracture Register. Acta Orthopaedica. 2022;93:684–688. doi: 10.2340/17453674.2022.4376
  22. Arias E. United States Life Tables 2010. Natl Vital Stat Rep. 2014;63(7):1–63.
  23. Jordan RW, Chahal GS, Davies M, Srinivas K. A comparison of mortality following distal femoral fractures and hip fractures in an elderly population. Adv Orthop Surg. 2014;2014:1–4. doi: 10.1155/2014/873785
  24. Didel R, Choudhary K. Epidemiology and Treatment of Distal Femoral Fractures in Adults: An Hospital Based Study. Asian Journal of Medical Research. 2019;8(1):OR12–OR14. doi: 10.21276/ajmr.2019.8.1.OR5
  25. Yamamoto N, Ohbe H, Tomita Y, et al. Associations between Early Surgery and Postoperative Outcomes in Elderly Patients with Distal Femur Fracture: A Retrospective Cohort Study. J Clin Med. 2021;10(24):5800. doi: 10.3390/jcm10245800
  26. Nyholm AM, Gromov K, Palm H, Brix M, Kallemose T, Troelsen A; Danish Fracture Database C. Time to surgery is associated with thirtyday and ninety-day mortality after proximal femoral fracture: a retrospective observational study on prospectively collected data from the Danish Fracture Database Collaborators. J Bone Joint Surg Am. 2015;97(16):1333–9. doi: 10.2106/JBJS.O.00029
  27. Zanchini F, Piscopo A, Cipolloni V, et al. Distal femur complex fractures in elderly patients treated with megaprosthesis: Results in a case series of 11 patients. World J Orthop. 2022;13(5):454–464. doi: 10.5312/wjo.v13.i5.454
  28. Hoffmann MF, Jones CB, Sietsema DL, Tornetta P 3rd, Koenig SJ. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res. 2013;8:43. doi: 10.1186/1749-799X-8-43
  29. Boureau F, Benad K, Putman S, Dereudre G, Kern G, Chantelot C. Does primary total knee arthroplasty for acute knee joint fracture maintain autonomy in the elderly? A retrospective study of 21 cases. Orthop Traumatol Surg Res. 2015;101(8):947–51. doi: 10.1016/j.otsr.2015.09.021
  30. Chen F, Li R, Lall A, Schwechter EM. Primary total knee arthroplasty for distal femur fractures: a systematic review of indications, implants, techniques, and results. Am J Orthop (Belle Mead NJ). 2017;46(3):E163–1.
  31. Wui NB, Anuar MA, Wahid AM. Short-term outcome of early primary Total knee Arthroplasty for fractures around the knee in the elderly population: the experience of a secondary healthcare Centre in Malaysia. Malaysian J Med Sci. 2020;27(4):64–71. doi: 10.21315/mjms2020.27.4.6
  32. Choi NY, Sohn JM, Cho SG, Kim SC, In Y. Primary total knee arthroplasty for simple distal femoral fractures in elderly patients with knee osteoarthritis. Knee Surg Related Res. 2013;25(3):141–6. doi: 10.5792/ksrr.2013.25.3.141
  33. Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop. 2018;42(1):191–6. doi: 10.1007/s00264-017-3665-1
  34. Konda SR, Pean CA, Goch AM, Fields AC, Egol KA. Comparison of short term outcomes of geriatric distal femur and femoral neck fractures: results from the NSQIP database. Geriatr Orthop Surg Rehabil. 2015;6(4):311–15. doi: 10.1177/2151458515608225

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-76249 от 19.07.2019.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies