Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: Insights from the National Trauma Data Bank

Tsai, Sung Huang Laurent; Lin, Tung-Yi; Tischler, Eric H.; Hung, Kuo-Hsien; Chen, Chien-Hao; Osgood, Greg; Fu, Tsai-Sheng; Su, Chun-Yi

doi:10.1016/j.injury.2021.04.023

Cited by 27 publications

(27 citation statements)

References 14 publications

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“…From January 10, 2015, to December 2019, there were more than 31,000 patients in the Medicare claims data who sustained an operatively managed distal femur fracture who met inclusion criteria. Most of the patients (90%, 28,251/ 31,380) received fixation with either ORIF (22,917) or IMN (5,334) (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, it is intuitive that patients with geriatric distal femur fracture and patients with geriatric hip fracture have similar mortality rates. Tsai et al 22 recently reported significantly greater in-hospital mortality in geriatric distal femur fractures as compared with geriatric hip fractures. This study is the largest study on geriatric distal femur fractures in the literature, and the overall 1-year mortality of 22.5% is similar to several previous studies ranging from 13% to 38%.…”

Section: Discussionmentioning

confidence: 99%

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Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications

DeKeyser

Martin

Marchand

et al. 2023

Journal of Orthopaedic Trauma

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Objective: Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femur replacement (DFR). Design: Retrospective comparison. Setting: Medicare beneficiaries. Patients/Participants: Patients 65 years of age and older with distal femur fracture identified using Center for Medicare & Medicaid Services data from 2016 to 2019. Intervention: Operative fixation (open reduction with plating or intramedullary nail) or DFR. Main Outcome Measurements: Mortality, readmissions, perioperative complications, and 90-day cost were compared between groups using Mahalanobis nearest-neighbor matching to account for differences in age, sex, race, and the Charlson Comorbidity Index. Results: Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 vs. 80.4 years, P < 0.001), and there were more an open fractures (1.6% vs. 0.5%, P < 0.001). There were no differences in 90-day (difference: 1.2% [−0.5% to 3%], P = 0.16), 6-month (difference: 0.6% [−1.5% to 2.7%], P = 0.59), and 1-year mortality (difference: −3.3% [−2.9 to 2.3], P = 0.80). DFR had greater 90-day (difference: 5.4% [2.8%–8.1%], P < 0.001), 6-month (difference: 6.5% [3.1%–9.9%], P < 0.001), and 1-year readmission (difference: 5.5% [2.2–8.7], P = 0.001). DFR had significantly greater rates of infection, pulmonary embolism, deep vein thrombosis, and device-related complication within 1 year from surgery. DFR ($57,894) was significantly more expensive than operative fixation ($46,016; P < 0.001) during the total 90-day episode. Conclusions: Elderly patients with distal femur fracture have a 22.5% 1-year mortality rate. DFR was associated with significantly greater infection, device-related complication, pulmonary embolism, deep vein thrombosis, cost, and readmission within 90 days, 6 months, and 1 year of surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications

DeKeyser

Martin

Marchand

et al. 2023

Journal of Orthopaedic Trauma

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“…Adults above the age of 49 had osteopenia or osteoporosis at rates of 22.4% and 47.9%, respectively [ 11 ]. Another study also indicated that distal femoral fracture was associated with higher mortality rates, as determined by a retrospective analysis after adjusting for potential factors [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study

ALJohani¹,

Alshugair²,

Alfadhel³

et al. 2022

Cureus

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Objective: The objective is to investigate one-year mortality rates following femur osteoporotic fractures, and to investigate factors that are associated with higher mortality rates. Design: A retrospective study was conducted from 2010 to 2021 (11 years) of all patients who presented to King Saud Medical City, Saudi Arabia, and had a fragility fracture of the proximal or distal femur. Patients: One hundred eight patients who sustained a proximal or distal femoral fracture, as a result of low-energy trauma, were included. Results: The majority of our cohort (77.8%) had proximal femoral fractures, whereas only 22.2% had a distal femoral fracture. 55.6% were less than 75 years old, and 44.4% were 75 years or older. All patients had fallen from standing height. Hypertension and diabetes were the most common comorbidities among our cohort at 49.1% and 47.2%, respectively, but neither showed a statistically significant increase in the risk of mortality. When assessing the overall mortality, 21.3% of our patients had passed away. Although this finding was not statistically significant, mortality rates were found to be higher in patients with proximal femoral fractures compared to distal femoral fractures (25% vs. 8.3%, respectively, p=0.095). Patients with a normal bone mass density (BMD) had higher mortality rates as opposed to those with abnormal BMD (p=0.001). Conclusions: Mortality rates are higher in proximal femoral fractures compared to distal femoral fractures. In addition, within our study cohort, patients with normal BMD had higher mortality rates. We recommend prospective studies that compare mortality rates between proximal and distal femoral fractures in patients with osteoporosis, as these studies would provide more accurate data. We also recommend having BMD measured in those patients to avoid further fractures in this patient population.

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“…In this study, mortality more than 8 days after ambulance transport or after transfer to other institutions was not able to be obtained and included. Meanwhile, Tsai et al [25] reported an in-hospital mortality rate of 6.7% within an average of 6.65 days of hospitalization. Some differences in patient demographics and data collection methods existed between the work by Tsai et al [25] and our study.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, Tsai et al [25] reported an in-hospital mortality rate of 6.7% within an average of 6.65 days of hospitalization. Some differences in patient demographics and data collection methods existed between the work by Tsai et al [25] and our study. Their data were collected from the United States National Trauma Data Bank registry, and data collection was limited to relatively severe patients over 65 years old with some kind of comorbid illness or secondary fractures due to high-energy trauma.…”

Section: Discussionmentioning

confidence: 99%

Incidence of and risk factors for hip fracture in Nagasaki, Japan from 2005 to 2014

et al. 2021

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Summary The annual incidence of new hip fractures increased from 2005 to 2014 in Nagasaki and females were much more affected. High-risk factors were identified as age ≥ 80 years, winter, indoors, living room, Monday, and early morning. Seven days after admission, most patients remained hospitalized and had been treated surgically. Introduction Hip fractures are major osteoporotic fractures that reduce quality of life. In Japan, the incidence of hip fractures increased steadily from 1986 to 2014 and the number of hip fractures could be 7.3–21.3 million by 2050. This study aimed to determine the incidence of hip fractures from 2005 to 2014 in Nagasaki Prefecture and to analyze the characteristics of and risk factors for hip fracture. Methods Hip fractures that occurred in Nagasaki Prefecture between 2005 and 2014 were analyzed using emergency transportation records. Fracture type, age, sex, location in which fracture occurred, and risk factors for hip fracture were clarified. Results The total number of new hip fractures among individuals ≥ 35 years old was 17,395 (mean age, 82.6 years old) and the annual incidence per 100,000 population increased from 147.9 in 2005 to 235.0 in 2014. Females (79.6%) were much more commonly affected than males (20.4%) and cervical fractures were more common than trochanteric fractures in all age groups. Hip fracture tended to be associated with age ≥ 80 years, winter rather than summer, indoors rather than outdoors, and living room rather than the bathroom or toilet. Other high-risk factors were Monday as day of the week, and early morning as the time of day. Seven days after admission, 97.3% of patients were hospitalized and 78.1% of hip fractures had been treated surgically. Conclusion Information on actual situations and valid preventive measures relevant to hip fracture are urgently needed.

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Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: Insights from the National Trauma Data Bank

Cited by 27 publications

References 14 publications

Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications

Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study

Incidence of and risk factors for hip fracture in Nagasaki, Japan from 2005 to 2014

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