Geriatric distal femur fracture: Are we underestimating the rate of local and systemic complications?

Moloney, Gele; Pan, Tao; Eck, Carola F. van; Patel, Devan; Tarkin, Ivan S.

doi:10.1016/j.injury.2016.05.024

Cited by 87 publications

(76 citation statements)

References 21 publications

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“…In the modern era of prophylactic antibiotic use, the incidence of SSI following surgically treated distal femoral fractures was not high, from 1.5% to 9.1% in different settings, consistent with ours (4.8%). In a study of distal intra‐articular fractures treated by locking compression plates, Sahu reported the early wound infection of 7.0% (12/170).…”

Section: Discussionsupporting

confidence: 89%

“…Another study in which dynamic condylar screw was used showed the post‐operative SSI was 7.0% within 1‐year follow‐up . Moreover, for elderly patients the post‐operative SSI was higher, being 9.1% . The varied SSI incidences reported among studies reflected the differences in definition of SSI, the confirmation form of SSIs, the patients' characteristics, post‐operative follow‐up period and others.…”

Section: Discussionmentioning

confidence: 99%

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Prolonged surgical duration, higher body mass index and current smoking increases risk of surgical site infection after intra‐articular fracture of distal femur

et al. 2019

ANZ Journal of Surgery

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Background: This study aimed to investigate incidence of surgical site infection (SSI) following the surgery of intra-articular fractures of distal femur. Methods: Between July 2014 and December 2017, inpatient medical records of consecutive patients who had intra-articular fractures of distal femur treated by open reduction and plate/screw fixation were inquired to identify whether they had a SSI. After discharge, patients who had a SSI and were readmitted for treatment of SSI were also allocated to the case group. Univariate and multivariate logistic regression analyses were performed to determine whether some clinical factors were independently associated with SSI, after adjustment for confounding variables. Results: During the study period, 434 patients were evaluated and 21 patients were confirmed to develop a SSI, indicating the accumulated incidence of 4.8% within 1 year. A total of six deep and 15 superficial SSIs were identified, with respective incidence being 1.4% and 3.4%. The most common causative pathogen was Staphylococcus aureus (8, 50.0%), followed by mixed bacteria (5, 31.3%). Open fracture, prolonged surgical duration, increased body mass index and current smoking were identified as independent risk factors for development of SSI (P < 0.05). Conclusions: It should be noted that it was likely difficult to modify these risk factors, but they do prove useful for preoperative counselling of patients and their relatives regarding their own risk profile of SSI, and the perioperative medical optimization.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prolonged surgical duration, higher body mass index and current smoking increases risk of surgical site infection after intra‐articular fracture of distal femur

et al. 2019

ANZ Journal of Surgery

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“…It is responsible for the high rates of morbidity and mortality 7,8 . It has a negative effect on the quality of life of the elderly [9][10][11] . Although changes in the bone density due to osteoporosis [12][13][14] have been associated with incidents of fractures of the femur for the older people, little is known about the profile of morbidity during the different conditions.…”

Section: Introductionmentioning

confidence: 99%

Determinantes socioeconômicos e demográficos na assistência à fratura de fêmur em idosos

Madeiras

Silva

Yamaguchi

et al. 2019

Ciênc. saúde coletiva

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Femur fracture affects the elderly with high morbidity and mortality. The purpose of the present study was to analyze the profile of the assistance given to the elderly who have femoral fractures, relating to their socioeconomic and demographic conditions, in the state of Paraná between the years 2008 to 2013. These relationships were obtained through factor analysis and the development and analysis of the following rates: PAE -the potential of primary health care to the elderly, whose variable was represented by the contribution of the elderly to the municipal GDP, PAP -the potential of the primary health care to the population, represented by GDP per capita and TEtreatment efficiency represented by the annual rate of fractures and annual rate of death per residence. The municipalities were classified according to the rate variation range. In relation to PAE, 10 municipalities were classified with low potential of care for the elderly, 357 with moderate potential and 32 had low potential. In relation to PAE, 12 municipalities were classified with low potential of primary care for the elderly, 303 with moderate potential and 84 had low potential. In relation to TE, 109 municipalities showed high treatment efficiency, 110 with moderate efficiency and 180 had low efficiency. Our conclusion was that the performance of the economy exerts significant influence on femoral fracture morbidity in the elderly.

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“…Previous work reported that in elderly populations with patients aged 77 and 82 years on average, approximately one third (34–41%) of the distal femoral fractures were periprosthetic or peri‐implant fractures . The broad range of comorbidities increases the risks of local and systemic complications and premature death after geriatric distal femoral fractures . In addition, elderly patients are frequently not compliant to partial weight‐bearing and thereby contribute to increasing the risk of fixation failure.…”

mentioning

confidence: 99%

“…The mortality rate in geriatric patients undergoing operative treatment after having sustained a distal femoral fracture can be as high as 30% within the first year after surgery . Early clinically relevant complications are reported in 37.5% of the cases with patients aged over 60 years, with non‐union rate accounting for up to 24%, taking into consideration that it could have been even higher due to patients who died before bone union . Currently, there are no existing guidelines and consensus on the operative and fixation techniques for complex distal femoral fractures, nor on the postoperative treatment regarding safe weight‐bearing in order to reduce morbidity and mortality rate…”

mentioning

confidence: 99%

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

Todorov

Zderic

Richards

et al. 2018

Journal Orthopaedic Research

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Treatment of complex osteoporotic distal femur fractures with the Less Invasive Stabilization System (LISS) has been associated with high complication rates. The aim of this study was to investigate the biomechanical competence of two different techniques of augmented versus conventional LISS plating. Unstable distal femoral fracture AO/OTA 33-A3 was created via osteotomies in artificial femora simulating osteoporotic bone. Three study groups, consisting of 10 specimens each, were created for fixation with either LISS plate, LISS plate with additional polylactide intramedullary graft, or LISS plate plus medial locking plate (double plating). All specimens were non-destructively tested under axial (20-150 N) and torsional (0-4 Nm) quasi-static loading. Each bone-implant construct was tested with two different working length (WL) configurations (long and short) of the LISS plate. Relative movements between the most medial superior and inferior osteotomy aspects were investigated via three-dimensional motion tracking analysis. Double plating revealed significantly smaller longitudinal and shear displacement than the other two techniques (p ≤ 0.001). In addition, LISS plus graft fixation was with significantly less longitudinal displacement in comparison to conventional LISS plating (p < 0.001). Long WL resulted in significantly higher longitudinal and shear displacement compared to short WL for LISS and LISS plus graft (p ≤ 0.032), but not for double plating (p > 0.999). In conclusion, intramedullary grafting resulted in significantly increased fracture stability under axial loading in comparison to conventional LISS plating. Although it was not efficient enough to provide comparable stability to double plating, intramedullary grafting may be considered as a useful biological alternative to the latter in a surgeon's armamentarium. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2604-2611, 2018.

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Geriatric distal femur fracture: Are we underestimating the rate of local and systemic complications?

Cited by 87 publications

References 21 publications

Prolonged surgical duration, higher body mass index and current smoking increases risk of surgical site infection after intra‐articular fracture of distal femur

Prolonged surgical duration, higher body mass index and current smoking increases risk of surgical site infection after intra‐articular fracture of distal femur

Determinantes socioeconômicos e demográficos na assistência à fratura de fêmur em idosos

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

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