Perioperative Considerations When Treating Isolated Periprosthetic Distal Femur Fractures.

BACKGROUND: Periprosthetic distal femur (PPDF) fractures occur most frequently via low energy mechanisms in elderly patients. This population is often frail and ill-suited to the physiologic burden of trauma and surgery. Here, we describe the perioperative and early hospital course for patients with PPDF fractures, and identify risk factors for poor outcomes. METHODS: Consecutive patients with isolated PPDF fractures from 2005 - 2015 were treated operatively at a Level I trauma center. Perioperative records were reviewed. Complications included wound complications, cardiac complications, pneumonia, thromboembolic events, urinary tract infections (UTIs), sepsis, multiple organ failure, death, and 90-day readmissions. RESULTS: Thirty-nine patients were treated operatively for isolated PPDF fractures. Mean age was 75.1 years old, 87.2% were women, and 92.3% occurred after falls from standing. Average American Society of Anesthesiologists score was 3.0. Thirty-six patients underwent open reduction and internal fixation with a mean operative time of 108 minutes. Excluding outliers, mean LOS was 4.6 days. Patients admitted to the ICU had longer LOS (p=0.03). Complications occurred in 17.9% of patients, including cardiac events (12.8%) and (5.1%) deaths. CONCLUSIONS: Patients with PPDF fractures frequently have underlying medical comorbidities. A complicated and/or protracted hospital course is not uncommon. Further study to optimize treatment appears warranted. Level of evidence: Prognostic, level 4.