Outcomes associated with distal femur fractures treated with distal femur replacement compared to open reduction internal fixation in elderly patients.

Abstract

Distal femur fractures in the elderly population are challenging to manage surgically. Treatment methods have traditionally focused on open reduction internal fixation (ORIF). More recently, distal femur replacement (DFR) has emerged as an alternative treatment method for geriatric distal femur fractures. DESIGN: Retrospective observational study. Data derived from TriNetX, a multicenter insurance claims database. 15,933 patients aged 65 years and older who sustained distal femur fractures and were treated with either DFR or ORIF within 30 days of injury were identified and matched, resulting in balanced cohorts of 584 patients each. Outcomes were analyzed at postoperative days 7, 30, and 90 as well as years 1 and 5. Endpoints were transfusion requirements, infections, revision surgery, and mechanical complications. The cohorts were matched using a greedy nearest neighbor algorithm, and the data was evaluated using relative risk (RR). After matching, at days 7, 30, and 90 postoperative, the DFR cohort showed an increased risk of transfusion when compared to the ORIF cohort (p = 0.025, p = 0.008, and p = 0.005, respectively). At 90 days postoperative, the DFR cohort had an increased rate of infection (p = 0.028). At postoperative years 1 and 5, the matched DFR cohort was found to have a significantly higher risk of revision surgery (p < 0.001) and mechanical complications (p < 0.001) compared to the ORIF cohort. This study found that the treatment of distal femur fractures with DFR is associated with a significantly higher risk of transfusion, infection, revision surgery, and mechanical complications compared to ORIF. This suggests that ORIF results in lower risk of complications in elderly patients with distal femur fractures.