Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff

Abstract

Background and objectives The mortality after hip, proximal femur, fractures in elderly patients has steadily declined in the last decade in the United Kingdom as a result of implementing of multiple protocols focusing on prompt multidisciplinary pre- and post-operative optimization and reducing time to surgery. The pinnacle of these protocols is the development of the best practice tariff as an incentive program for hospitals that meet set criteria by the National Health Service (NHS) England in managing these injuries. Until the time of writing this paper, there was no parallel program for the management of fractures involving distal femur in the elderly. The aim of this study is to evaluate the outcomes of distal femur fractures in elderly patients against proximal femur fractures regarding post-injury mortality, the prevalence of surgical treatment and time delay till surgery. Methods A retrospective study of all patients above the age of 60 admitted to Queens Hospital Burton between 2010 and 2014 with fractures involving distal end of the femur. Patient data were assessed for demographic criteria, co-morbidities as per Charleston Comorbidities Index, type of management, time-lapse before surgery and 30-day, six-month and one-year mortality. Results were compared to an age-matched control group of patients with proximal femur fractures randomly selected during the same time window. Results The main demographic criteria such as age, gender, and Charleston Comorbidities Index were similar in both groups. There were more patients treated non-operatively in the distal femur group than in the proximal femur group (15% vs 4%). Time to surgery was statistically significantly longer in distal femur group compared to the proximal femur (49.130 hours vs 34.075 hours, P = 0.041). The mortality in distal femur group was higher at all times (9.68% at 30 days, 20.32% at six months and 34.41% at one year) when compared to that in the proximal femur group (6.99% at 30 days, 14.52% at six months, 21.51% at one year). Conclusion The distal femoral fractures showed higher mortality at 30 days, six months and one year compared to the proximal femur group. This could be partly influenced by the implementation of best practice tariff in the proximal femur fracture group reflected in less time to surgery, pre- and post-operative multidisciplinary approach and more frequent operative management.

Comparable Outcomes Between Native and Periprosthetic Fractures of the Distal Femur

“…9 10 11 The literature describing distal native femur fractures report 1-year mortality rate between 13.4 and 34.4%; however, these fractures have yet to be compared widely to periprosthetic distal femur fractures. 12 13 Periprosthetic distal femur fracture morbidity and mortality remain ill-defined with few large-scale studies investigating the morbidity and mortality. 14 Furthermore, there are few previous studies comparing the morbidity and mortality to a more well-known entity such as native distal femur fractures.…”

Five-year risk of fracture and subsequent fractures among adults with cerebral palsy

“…Knowledge of the site distribution of initial and subsequent fragility fractures has clinical implications. Certain fracture sites can be challenging to clinically manage, such as the distal femur, which is associated with heightened mortality rates compared to other fracture sites among the general elderly population ( Mubark et al, 2020 ). The differential risks by fracture site may be exacerbated in adults with CP.…”

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

“…In contrast with our results, Mubarak et al reported that compared to the mortality rate in the proximal femoral group (6.99% at 30 days, 14.52% at six months, and 21.51% at one year), the distal femoral group was greater at all times (9.68% at 30 days, 20.32% at six months, and 34.41% at one year). Moreover, the same study indicated that a higher number of patients with distal femoral fractures were treated without surgical intervention (15% vs. 4%) [ 10 ].…”