Abstract
Introduction
The incidence of distal femoral fractures amongst elderly patients is likely to rise due to increased life expectancy. This study reports on the outcome of a series of distal femoral fractures treated by retrograde femoral nailing and then to compare the results for these patients with a series of patients with a proximal femoral fracture.
Materials and/Methods
In this longitudinal cohort study, 36 patients with extra-articular distal femoral fractures were treated with a solid retrograde femoral nail. Data was collected prospectively and then compared to proximal femoral fractures (2426) treated by the same surgeon treated over the same time period.
Results
Within the distal femoral group 97% of the patients were female, with a mean age of 81 years. The mean length of hospital stay amongst the distal femoral group was slightly higher (19 days) compared to the proximal femoral group (18 days). All the post-operative complications were higher amongst the distal femoral group which included deep vein thrombosis 8% vs 2%, pneumonia 5% vs 3%, superficial wound infection 5% vs 3% and deep wound infection 2% vs 1%. 5% of patients in the proximal femoral group required revision surgery whereas none in the distal femoral group did. The survival analysis curve indicated to an increased trend in mortality amongst the distal femoral group however due to the small sample size this did not reach statistical significance.
Conclusions
Our study shows that there is a significant morbidity and mortality amongst patients who have sustained a distal femoral fracture. Given the significant risk that elderly patients have we propose that distal femoral fractures should be treated with prompt surgical fixation with an emphasis on early rehabilitation and safe discharge.
