Suh Yu Min, Smith Abigail, Hu Di, Lin Feng-Chang, Chen Andrew
Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
OTA Int. 2025 Aug 1;8(3):e421. doi: 10.1097/OI9.0000000000000421. eCollection 2025 Sep.
Hip fractures in patients with end-stage renal disease (ESRD) are associated with high mortality rates. The effect of ESRD on mortality after operative treatment of distal femur fractures is not known. Our hypothesis was that distal femur fractures carry a similar mortality risk and complication rate compared with proximal femur fractures in patients with ESRD.
A retrospective database study using the United States Renal Data System registry.
Not applicable.
Patients with ESRD who underwent operative fixation of proximal or distal femur fractures.
All-cause mortality risk and survival rates were calculated using Kaplan-Meier analysis. The results were adjusted for potential confounding variables including age, body mass index, sex, comorbidities, and duration of dialysis. Complications were analyzed with the χ test and one-way analysis of variance with the level of significance set at < 0.05.
In patients with ESRD who sustained a proximal (6118) or distal (430) femur fracture, the mortality rate was, respectively, 50.1% and 45.8% at 1 year ( = 0.09), and 68.0% and 62.6% ( = 0.02) at 2 years. The adjusted risk of death was not different between ESRD patients with a proximal or a distal fracture (hazard ratio = 1.08, 95% confidence interval: 0.95-1.23, = 0.23). Rate of venous thromboembolic events at 90 days was similar between both groups (4.1% vs. 4.4%, = 0.72) as well as pneumonia (11.8% vs. 10.7%, = 0.48).
In patients with ESRD, mortality rates after distal femur fractures were high and similar to mortality rates after hip fractures.
Level III; retrospective cohort study.
终末期肾病（ESRD）患者的髋部骨折与高死亡率相关。ESRD对股骨远端骨折手术治疗后死亡率的影响尚不清楚。我们的假设是，与ESRD患者的股骨近端骨折相比，股骨远端骨折的死亡风险和并发症发生率相似。
使用美国肾脏数据系统登记处进行回顾性数据库研究。
不适用。
接受股骨近端或远端骨折手术固定的ESRD患者。
使用Kaplan-Meier分析计算全因死亡风险和生存率。结果针对潜在的混杂变量进行了调整，包括年龄、体重指数、性别、合并症和透析时间。使用χ检验和单因素方差分析对并发症进行分析，显著性水平设定为<0.05。
在发生股骨近端（6118例）或远端（430例）骨折的ESRD患者中，1年时的死亡率分别为50.1%和45.8%（P = 0.09），2年时分别为68.0%和62.6%（P = 0.02）。ESRD患者近端或远端骨折的调整后死亡风险无差异（风险比=1.08，95%置信区间：0.95-1.23，P = 0.23）。两组90天时静脉血栓栓塞事件的发生率相似（4.1%对4.4%，P = 0.72），肺炎发生率也相似（11.8%对10.7%，P = 0.48）。
在ESRD患者中，股骨远端骨折后的死亡率很高，与髋部骨折后的死亡率相似。
III级；回顾性队列研究。
