Current standard of care for distal femur fractures in Germany and Switzerland

• Published in: Injury Vol. 54; no. 10; p. 110936
• Main Authors: Von Rehlingen-Prinz, F., Eggeling, L., Dehoust, J., Huppke, C., Strahl, A., Neumann-Langen, M.V., Glaab, R., Frosch, K.H., Krause, M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2023
• Subjects: Complications; Distal femur; Double plate; Fracture; Geriatric; Locking plates; Locking plates; Fracture; Distal femur; Complications; Geriatric; Double plate
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.110936

•Treatment reality of distal femur fractures in Germany and Switzerland.•Lateral plate osteosynthesis is the standard treatment for distal femoral fractures in our collective.•Complications occurred in 14.4% of the cases, requiring revision surgery.•Increased BMI, fracture dislocation over half a shaft width, and AO C (AO C2) fractures significantly raise the risk of complications. Distal femur fractures occur with an incidence of 4.5/100,000 and show a prevalence of 0.4%. Causes include low-impact trauma in older patients and high-impact trauma in younger patients without pre-existing medical conditions. The aim of this study was to perform a comprehensive evaluation of trauma mechanisms, trauma-promoting factors, comorbidities, medication history and type of surgical care to provide an overview of the causes of injury and the most appropriate therapeutic approach. In this multicenter cohort study a retrospective analysis of 229 patients who sustained a distal femur fracture between January 2011 and December 2020 was performed. Individual fracture patterns, fracture predisposing factors, concomitant disease profiles, medication history, treatment strategy and associated complications were analyzed. 229 patients were included in the retrospective analysis. A total of 113-type 33 A, 50-type 33 B and 66-type 33 C fractures were diagnosed, of whom 92% received a lateral locking plate osteosynthesis. There was a complication in 14.4% of all cases, of which 6.1% were attributable to infection. Significant risk factors for developing a complication were an increased BMI (29.9 ± 8.5 kg/m2; p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AOC fractures (p < 0,016), specifically C2 fractures (p < 0,008). In this multicenter retrospective cohort study, lateral locking plate osteosynthesis was the method of choice and was selected in over 90% of cases, regardless of the fracture classification and risk factors. A complication rate of 14.4% emphasizes the necessary analysis of patient- and care-specific risk factors and a resulting adjustment of the therapy strategy. An increased BMI (29.9 ± 8.5 kg/m2; p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AOC fractures (p < 0,016), specifically C2 fractures (p < 0,008) increase the risk of developing a complication and should prompt an early switch to a treatment strategy that provides more stability.