Abstract
Background:Distal femoral fractures account for 3-6% of adult femoral fractures and 0.4% of all fractures and are associated with significant morbidity and mortality rates. As countries develop inter-hospital trauma networks and adapt healthcare policy for an aging population there is growing importance for research within this field.Methods:Hospital coding and registry records at the central London Major Trauma Center identified 219 patients with distal femoral shaft fractures that occurred between December 2010 and January 2016. CT-Scans were reviewed resulting in exclusion of 73 inappropriately coded, 10 pediatric and 12 periprosthetic cases. Demographics, mechanism of injury, AO/OTA fracture classification and management were analyzed for the remaining 124 patients with 125 fractures. Mann Whitney U and Chi Squared tests were used during analyses.Results:The cases show bimodal distribution with younger patients being male (median age 65.6) compared to female (median age 71). Injury caused through high-energy mechanisms were more common in men (70.5%) whilst women sustained injuries mainly from low-energy mechanisms (82.7%) (p<0.0001). Majority of fractures were 33-A (52.0%) followed by 33-B (30.4%) and 33-C (17.6%). Ninety-two (73.6%) underwent operative management. The most common operation was locking plates (64.1%) followed by intramedullary nailing (19.6%).Interpretation:The epidemiology of a rare fracture pattern with variable degrees of complexity is described. A significant correlation between biological sex and mechanism of injury was identified. The fixation technique favored was multidirectional locking plates. Technical requirements for fixation and low prevalence of 33-C fractures warrant consideration of locating treatment at centers with high caseloads and experience.
Highlights
Distal femoral fractures represent 3-6% of femoral fractures and 0.4% of all fractures [1, 2]
This paper aims to report the experience of a Central London Major Trauma Center (MTC) in managing adult distal femoral fractures over a five-year period
Had the population remained static over a five year and two month period, our study indicates distal femoral fractures that present to MTC status hospitals have an incidence of 8/million/year in an area covering one quarter of Greater London
Summary
Distal femoral fractures represent 3-6% of femoral fractures and 0.4% of all fractures [1, 2]. The literature appreciates a classical bimodal age distribution with younger patients more likely to be male involved in high-energy trauma and older patients are more likely to be female with injury sustained from low-energy etiology such as fall from standing [3]. The rapidly ageing population will be responsible for an increased number of fragility fractures affecting the knee [5]. The Open Orthopaedics Journal, 2017, Volume 11 the mortality for elderly patients who sustain these injuries may be as high as 18.4%, 39.1% and 48.8% at one, three and five years respectively [6]. The treatment of distal femoral fractures remains a challenge, in particular AO/OTA type B and C [7 - 9]. Distal femoral fractures account for 3-6% of adult femoral fractures and 0.4% of all fractures and are associated with significant morbidity and mortality rates. As countries develop inter-hospital trauma networks and adapt healthcare policy for an aging population there is growing importance for research within this field
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