Fri., 10/15/10 Geriatrics, Paper #46, 10:57 am OTA-2010
Mortality after Distal Femur Fractures in Elderly Patients
Philipp N. Streubel, MD; William M. Ricci, MD; Ambrose Wong, BS; Michael J. Gardner, MD;
Washington University School of Medicine, St. Louis, Missouri, USA
Purpose: Although hip fractures in the elderly are associated with high 1-year mortality rates, it is not clear whether patients with other lower extremity fractures are exposed to a similar mortality risk. The purpose of this study was to compare survivorship of elderly patients with distal femur fractures to a matched hip fracture control group. The null hypothesis was that similar mortality rates would be found. Additionally, we aimed at identifying predictors for mortality after distal femur fractures.
Methods: 92 consecutive patients with low-energy supracondylar femur fractures admitted between 1999 and 2009 were included (mean age 77.9, years; 78% females; average follow-up 2.8 years; mean Charlson Comorbidity Index [CCI], 1.8). Patient, fracture, and treatment characteristics were extracted from operative records, charts, and radiographs. Data on mortality were obtained from the Social Security Death Index. A 1:1 age, gender, comorbidity, and follow-up–matched hip fracture control group (n = 92) was evaluated.
Results: Distal Femur Versus Hip Fracture Survival. Overall mortality rates for distal femur and hip fracture patients were each 38% (P = 1.00). Equality was confirmed with log-rank test (P = 0.83, power=0.80). One-year mortality was 25% after distal femur fracture and 21% after hip fracture (P = 0.55). Distal Femur Fracture Survival. Age-adjusted CCI and the presence of a previous total knee arthroplasty led to shorter survival (hazard ratio [HR] = 3.21, P = 0.005 and HR = 1.32, P = 0.004 respectively). Congestive heart failure (HR = 4.52, P < 0.001), dementia (HR = 4.52, P = 0.002), moderate to severe renal disease (HR = 4.67, P = 0.001), and history of a malignant tumor (HR = 2.9, P = 0.02) lead to significantly shorter survival times. The effect of gender, smoking habit, body mass index, fracture classification, and delay to surgery on survival was not significant.
Conclusions: Mortality after fractures of the distal femur in the geriatric population is high and similar to the mortality seen after hip fractures. Periprosthetic fractures and those occurring in patients with dementia, heart failure, advanced renal disease, and metastasis lead to a significant reduction in survival. Age-adjusted CCI may serve as a useful tool to predict survival after distal femur fractures.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.