Abstract
Distal femoral fractures account for 3-6% of all femoral fractures with a similar demographic as patients suffering from proximal femoral fractures. The mortality risk can be high in such injuries, which has prompted NHS England to extend the scope of the Best Practice Tariff to include all fragility fractures of the femur. Poor bone quality, intra-articular extension, and significant comminution can make these fractures difficult to manage with fixation techniques, while early mobilisation is a key outcome in the treatment of this injury.In this study, a comprehensive literature search was performed based on keywords, and abstracts were reviewed to identify relevant articles. The following factors were analysed: time to surgery, time to full weight-bearing, the average hospital stay, post-operative mobility status, and complications.A total of 233 abstracts were identified using the pre-determined search criteria, and, subsequently, articles were excluded following author review. A total of 10 relevant articles were included in this review, with five used for review and comparison between distal femoral replacement (DFR) and fixation. This resulted in a sample of 200 patients treated with DFR with over 87% ambulatory at follow-up and a re-operation rate of 13.3% compared to 78% and 13.5%, respectively, in those treated with open reduction internal fixation (ORIF) procedure.Despite a limited pool of evidence, the literature suggests that DFR offers an option that potentially allows immediate weight-bearing and leaves most patients ambulatory at follow-up. Although DFR is more costly than other operative techniques, it avoids complications associated with fixation such as non-union and can reduce the risk of further surgery through direct complications or a need for delayed arthroplasty, which is deemed more complex secondary to fixation. Early mobilisation is a key step in reducing morbidity and mortality among this cohort of patients, and a procedure such as DFR should be more widely considered to help achieve this outcome.
Highlights
BackgroundNHS England extended the scope of the Best Practice Tariff (BPT) for fragility hip fractures to include fractures of the femoral shaft and distal femur [1]
A total of 10 relevant articles were included in this review, with five used for review and comparison between distal femoral replacement (DFR) and fixation
Distal femoral fractures account for 3-6% of all femoral fractures and have a similar demographic as patients suffering from proximal femoral fractures, with an average age of 82.4 years and 83.7 years, respectively [2]
Summary
NHS England extended the scope of the Best Practice Tariff (BPT) for fragility hip fractures to include fractures of the femoral shaft and distal femur [1]. This change occurred in April 2020 and ensured that patients with distal femur fractures were given the same holistic care as those with proximal femur fractures. The comorbidity profile is similar, and the 30-day and one-year risk of mortality can be high in such injuries In the elderly, these fractures are predominantly caused by low energy trauma resulting in fractures within the region extending from the metaphyseal-diaphyseal junction to the articular surface. Intra-articular extension, and level of comminution can make it difficult to achieve adequate reduction and fixation in these fractures
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