Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2021

01-08-2021 | Original Article

Injury patterns and outcomes associated with fractures of the native distal femur in adults

Authors: David Roy, David Ramski, Ajith Malige, Matthew Beck, Kirk Jeffers, Patrick Brogle

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2021

Login to get access

Abstract

Purpose

Previous studies on distal femur fractures had a high degree of inclusion criteria in their sample populations, some even including pre-existing implants. The authors look to define an injury pattern unique to fractures of the distal femur by detailing demographics, associated injuries, and outcomes.

Methods

This retrospective chart review identified 171 patients who presented to our Level 1 academic trauma center with a distal femur fracture, of which 91 injuries met inclusion for final analysis. For each patient, demographics, fracture classification, associated injuries, hospital outcomes, union rate, and complication rate were recorded. These characteristics were compared in high-energy injury versus low-energy injuries.

Results

Additional orthopedic injuries, most commonly an ipsilateral patella or tibia fracture (p = 0.02), were more likely to occur in patients who sustained high-energy injuries (86%, p = 0.0001). High-energy injuries resulted in more severe distal femur fracture types and significantly greater rate of open fractures (19.8% of all fractures, p = 0.0001). High-energy injuries were also associated with long operating room times during fixation (p < 0.001), estimated blood loss during surgery (p = 0.03), and hospital length of stay (p = 0.04). Finally, high-energy injuries were also associated with lower union rates (p = 0.036) and a higher rate of additional surgeries (p = 0.011).

Conclusion

Patients who sustain a distal femur fracture have a greater risk for additional fractures (particularly ipsilateral tibia and patella fractures), open injuries, and non-orthopedic traumatic injuries. These high-energy injuries are also associated with a more complicated clinical course and lower rate of union compared to low-energy injuries.

Level of evidence

Prognostic level III.
Literature
1.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–7.CrossRef
2.
Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop. 1982;53:957–62.CrossRef
3.
Martinet O, Cordey J, Harder Y, Maier A, Bühler M, Barraud GE. The epidemiology of fractures of the distal femur. Injury. 2000;1(31):62–94.CrossRef
4.
Gwathmey WF, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. J Am Acad Orthop Surg. 2010;18(10):597–607.CrossRef
5.
Pietu G, Lebaron M, Flecher X, Hulet C, Vandenbussche E. Epidemiology of distal femur fractures in France in 2011–12. Orthop Traumatol Surg Res. 2014;100(5):545–8.CrossRef
6.
Arneson TJ, Lewallen DG, O'Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965–1984. Clin Orthop Rel Res. 1988;234:188–94.
7.
Boyd AD Jr, Wilber JH. Patterns and complications of femur fractures below the hip in patients over 65 years of age. J Orthop Trauma. 1992;6:167–74.CrossRef
8.
Neer CS 2nd, Grantham SA, Shelton ML. Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J Bone Jt Surg. 1967;49:591–613.CrossRef
9.
Pettine KA. Supracondylar fractures of the femur: long-term follow-up of closed versus nonrigid internal fixation. Contemp Orthop. 1990;21:253–61.PubMed
10.
Schatzker J, Home G, Waddell J. The Toronto experience with the supracondylar fracture of the femur, 1966–72. Injury. 1974;6:113–28.CrossRef
11.
Schatzker J, Lambert DC. Supracondylar fractures of the femur. Clin Orthop Rel Res. 1979;138:77–83.
12.
Stewart MJ, Sisk TD, Wallace SLJ. Fractures of the distal third of the femur: a comparison of methods of treatment. J Bone Jt Surg. 1966;48:784–807.CrossRef
13.
Krettek C, Schandelmaier P, Lobenhoffer P, Tscherne H. Complex trauma of the knee joint. Diagnosis–management–therapeutic principles. Der Unfallchirurg. 1996;99:616–27.CrossRef
14.
Pritchett JW. Supracondylar fractures of the femur. Clin Orthop Rel Res. 1984;184:173–7.
15.
Smith JR, Halliday R, Aquilina AL, Morrison RJ, Yip GC, McArthur J, et al. Distal femoral fractures: the need to review the standard of care. Injury. 2015;46(6):1084–8.CrossRef
16.
Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Clin Orthop Rel Res. 2011;469(4):1188–96.CrossRef
17.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1–S133.CrossRef
18.
Nork SE, Segina DN, Aflatoon K, Barei DP, Henley MB, Holt S, et al. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. J Bone Jt Surg. 2005;87(3):564–9.CrossRef
19.
Cronier P, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R. The concept of locking plates. Orthop Traumatol Surg Res. 2010;96(4):S17–S36.CrossRef
20.
Tank JC, Schneider PS, Davis E, Galpin M, Prasarn ML, Choo AM, et al. Early mechanical failures of the synthes variable angle locking distal femur plate. J Orthop Trauma. 2016;30(1):e7–e11.CrossRef
21.
McDonald TC, Lambert JJ, Hulick RM, Graves ML, Russell GV, Spitler CA, et al. Treatment of distal femur fractures with the DePuy-Synthes variable angle locking compression plate. J Orthop Trauma. 2019;33(9):432–7.CrossRef
Metadata
Title
Injury patterns and outcomes associated with fractures of the native distal femur in adults
Authors
David Roy
David Ramski
Ajith Malige
Matthew Beck
Kirk Jeffers
Patrick Brogle
Publication date
01-08-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01287-y

Other articles of this Issue 4/2021

European Journal of Trauma and Emergency Surgery 4/2021 Go to the issue

Original Article

Ligamentous Lisfranc injuries: analysis of CT findings under weightbearing

Original Article

Distal pressure monitoring and titration with percent balloon volume: feasible management of partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA)

Review Article

Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review

Original Article

Outcome after treatment of distal radius fractures in the elderly using the IlluminOss® System

Original Article

Diagnostic value of intraoperative tap test for acute deltoid ligament injury

Original Article

Chest tube output, duration, and length of stay are similar for pneumothorax and hemothorax seen only on computed tomography vs. chest radiograph