Revision Arthroplasty
Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older

https://doi.org/10.1016/j.arth.2016.06.006Get rights and content

Abstract

Background

The ideal management of distal femur fractures in the elderly is unclear. Acute arthroplasty has the theoretical advantage of earlier mobilization. We examined the outcomes of patients 70 years and older who underwent open reduction internal fixation (ORIF) vs distal femoral replacement (DFR) for comminuted, intra-articular distal femur fractures.

Methods

A retrospective review of patients with AO/OTA classification 33C distal femur fractures treated with either ORIF or DFR was performed. Outcomes including all-cause reoperation, length of stay, fracture union, postoperative complications, use of ambulatory device and living situation at 1 year, and mortality were evaluated.

Results

The study cohort included 38 patients: 10 underwent DFR and 28 ORIF. Mean patient age for both cohorts was 82 years. No difference in comorbidities or mechanism of injury was found between groups. The incidence of reoperation was 11% in the ORIF group and 10% in the DFR group. In the ORIF group, the average time to fracture union was 24 weeks, with a nonunion incidence of 18%. Twenty-three percent of ORIF group were wheelchair dependent vs none in the DFR cohort, although not statistically significant. Differences between the groups with respect to all-cause reoperation, living situation or need for ambulatory device at 1 year, and 1-year mortality did not reach statistical significance.

Conclusion

Nearly 1 in 5 patients older than 70 years developed a nonunion after ORIF of an intra-articular distal femur fracture. At 1-year follow-up, all patients in DFR group were ambulatory while 1 in 4 in the ORIF group were wheelchair bound.

Section snippets

Methods

After obtaining institutional review board approval, we performed a retrospective review of patients treated for distal femur fractures at our institution from 2007 to 2012. Patients were included if they were aged 70 years or older and had sustained a comminuted, intra-articular (AO/OTA classification 33C) distal femur fracture (Fig. 1). Exclusion criteria included an inability to ambulate before injury, fractures above a total knee arthroplasty, and the presence of bilateral injuries. Using

Results

A total of 229 patients underwent treatment for 230 distal femur fractures at our institution from 2007 to 2012. One patient died before treatment, and 33 fractures were treated nonoperatively. The remaining 196 fractures were classified according to the AO/OTA system, allowing the exclusion of 61 A-type and B-type fractures as well as 69 periprosthetic fractures. Twenty-eight of these remaining 66 total C-type fractures were then excluded as they occurred in patients younger than 70 years of

Discussion

Intra-articular distal femur fractures present operative challenges for physicians and result in significant morbidity for elderly patients. Prolonged periods of protected weight bearing, limited fixation secondary to poor bone stock, and increased risk of nonunion 12, 13, 14, 15 pose technical challenges. We retrospectively evaluated the experience at our institution treating comminuted, complete articular distal femur fractures in patients older than 70 years with either ORIF or DFR

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.06.006.

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