Geriatric Distal Femur Fractures Treated With Distal Femoral Replacement Are Associated With Higher Rates of Readmissions and Complications

Objective: Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femur replacement (DFR). Design: Retrospective comparison. Setting: Medicare beneficiaries. Patients/Participants: Patients 65 years of age and older with distal femur fracture identified using Center for Medicare & Medicaid Services data from 2016 to 2019. Intervention: Operative fixation (open reduction with plating or intramedullary nail) or DFR. Main Outcome Measurements: Mortality, readmissions, perioperative complications, and 90-day cost were compared between groups using Mahalanobis nearest-neighbor matching to account for differences in age, sex, race, and the Charlson Comorbidity Index. Results: Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 vs. 80.4 years, P, 0.001), and there were more an open fractures (1.6% vs. 0.5%, P, 0.001). There were no differences in 90-day (difference: 1.2% [20.5% to 3%], P = 0.16), 6-month (difference: 0.6% [21.5% to 2.7%], P = 0.59), and 1-year mortality (difference: 23.3% [22.9 to 2.3], P = 0.80). DFR had greater 90-day (difference: 5.4% [2.8%-8.1%], P, 0.001), 6-month (difference: 6.5% [3.1%-9.9%], P, 0.001), and 1-year readmission (difference: 5.5% [2.2-8.7], P = 0.001). DFR had significantly greater rates of infection, pulmonary embolism, deep vein thrombosis, and device-related complication within 1 year from surgery. DFR ($57,894) was significantly more expensive than operative fixation ($46,016; P, 0.001) during the total 90-day episode. Conclusions: Elderly patients with distal femur fracture have a 22.5% 1-year mortality rate. DFR was associated with significantly greater infection, device-related complication, pulmonary embolism, deep vein thrombosis, cost, and readmission within 90 days, 6 months, and 1 year of surgery.