Loosen Antonia, Fritz Yannick, Dietrich Michael
Department for General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
Department for General, Trauma and Orthopaedic Surgery, City Hospital Waid Zurich, Zürich, Switzerland.
Geriatr Orthop Surg Rehabil. 2019 Jul 2;10:2151459319860723. doi: 10.1177/2151459319860723. eCollection 2019.
The treatment of distal femur fractures in geriatric patients is challenging and has a high perioperative morbidity and mortality. Treatments have evolved significantly in the past decades. The aim of our study was to analyze local and systemic morbidity and mortality, as well as functional results in this frail cohort treated with distal femur locking plates.
In this single-institution case series, we retrospectively analyzed the data of patients aged 65 years and older with fractures of the distal femur between March 2013 and March 2018. All patients were operated with distal femur locking plates. Points of interest included perioperative morbidity, mortality, weight-bearing status, and care-dependency after hospital discharge.
We assessed 49 patients (median age: 86.5 years) with 52 distal femur fractures (AO type A 77%, type C 15%, type B 8%). A total of 30 (58%) periprosthetic fractures with 4 (8%) interimplant femur fractures were documented. The perioperative morbidity was 64%, and the 3-month and 1-year mortality rates were 29% and 35%, respectively. The local complication rate was 6% with no documented implant failure. Of the patients who were living at home before the surgery, 62% required long-term accommodation in residential or nursing homes after dicharge from the hospital or short-term rehabilitation.
Geriatric patients with distal femur fractures face a high perioperative mortality. Osteosynthesis with distal femur locking plates is a reliable technique that can be used in various fracture patterns including periprosthetic and interimplant fractures.
老年患者股骨远端骨折的治疗具有挑战性，围手术期发病率和死亡率较高。在过去几十年中，治疗方法有了显著发展。我们研究的目的是分析在这个使用股骨远端锁定钢板治疗的脆弱队列中的局部和全身发病率、死亡率以及功能结果。
在这个单机构病例系列中，我们回顾性分析了2013年3月至2018年3月期间65岁及以上股骨远端骨折患者的数据。所有患者均采用股骨远端锁定钢板进行手术。关注要点包括围手术期发病率、死亡率、负重状态以及出院后的护理依赖情况。
我们评估了49例患者（中位年龄：86.5岁），共52处股骨远端骨折（AO分型：A型77%，C型15%，B型8%）。共记录到30例（58%）假体周围骨折，其中4例（8%）为植入物间股骨骨折。围手术期发病率为64%，3个月和1年死亡率分别为29%和35%。局部并发症发生率为6%，未记录到植入物失败情况。术前在家居住的患者中，62%在出院或短期康复后需要长期入住养老院或疗养院。
老年股骨远端骨折患者围手术期死亡率较高。股骨远端锁定钢板内固定是一种可靠的技术，可用于包括假体周围骨折和植入物间骨折在内的各种骨折类型。
