Distal femoral fractures in the elderly: Reduced mortality rates with locking plates?

Abstract

Distal femoral fractures (DFF) are associated with high mortality rates in the elderly and are particularly challenging to treat in this high risk population. Our aim was to evaluate the effectiveness of our management of DFF. Methods: 78 patients with DFF were included in a retrospective study at our department, from 2006-2012. Data was collected on: demographics, injury related data and outcomes. Results Demographics: The majority of our study population constituted females older than 65 years old. Injury related data: 78% of fractures were native DFF and 22% peri-prosthetic. 67% of patients underwent operative intervention. Outcomes: 68% of patients regained their pre-operative mobility status. Greatest length of hospital stay was found with increasing age and our overall 1-year mortality rate was 26%. Both mortality rate and length of stay were found to be least with the use of locking plates and greatest in those treated conservatively. Conclusion: DFF are likely to increase given the ageing population. Although our study was small, we propose surgical management of DFF provides better mortality outcomes amongst the elderly population, particularly when treated with locking plates. We also suggest patients should receive early routine orthogeriatric review to minimise delay to surgery to improve outcome.