Abstract
Background
Hip fracture care has evolved, largely due to standardisation of practice, measurement
of outcomes and the introduction of the Best Practice Tariff, leading to the sustained
improvements documented by the National Hip Fracture Database (NHFD). The treatment
of distal femoral fractures in this population has not had the same emphasis. This
study defines the epidemiology, current practice and outcomes of distal femoral fractures
in four English centres.
Patients and methods
105 patients aged 50 years or greater with a distal femoral fracture, presenting to
four UK major trauma centres between October 2010 and September 2011 were identified.
Data was collected using an adapted NHFD data collection tool via retrospective case
note and radiograph review. Local ethics approval was obtained.
Results
Mean age was 77 years (range 50–99), with 86% female. 95% of injuries were sustained
from a low energy mechanism, and 72% were classified as either 33-A1 or 33-C1. The
mean Parker mobility score and Barthel Independence Index were 5.37 (0–9) and 75.5
(0–100) respectively. Operative management was performed in 84%, and 86% had their
surgery within 36 h. Three quarters were fixed with a peri-articuar locking plate. There was no consensus
on post operative rehabilitation, but no excess of complications in the centres where
weight bearing as tolerated was the standard. 45% were seen by an orthogeriatrician
during their admission. Mean length of stay was 29 days. Mortality at 30 days, 6 months,
and 1 year was 7%, 16% and 18% respectively.
Discussion
This study demonstrates that the distal femoral and hip fracture populations are similar,
and highlights the current disparity in their management. The metrics and standards
of care currently applied to hip fractures should be applied to the treatment of distal
femoral fractures. Optimal operative treatment and rehabilitation remains unclear,
and is in need of further research.
Keywords
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Article info
Publication history
Published online: February 25, 2015
Accepted:
February 19,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
