Current Concepts in Management of Distal Femur Fractures.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest The authors declare there are no financial conflicts of interest to disclose. 4. J Orthop Trauma. 2025 Dec 1;39(12):644-652. doi: 10.1097/BOT.0000000000003059. Outcomes After Distal Femur Replacement for Fracture: A Multi-Institutional Retrospective Review. Landy DC(1), Foster JA(2), Southall WGS(3), Gregg AT(4), Duncan ST(3), Archdeacon MT(5), Obremskey WT(6), Lawrenz JM(6), Lee C(7), Sridhar MS(8), Aneja A(4); “DFR Research Group”. Collaborators: Ly TV, Griffin JT, Muhammad M, Wagner RK, Borgida JS, Sierra-Arce CR, Musick AN, Policicchio TJ, Kurkowski S, Trochez KM, Hajdu KS, Rodriguez E, Libos A, Moreno-Diaz AF, Zukotynksi BK, Gurich RW, Adams KJ, Bray E, Cannada LK, Ryan SP, Guenthner GP, Gauthier N, Gonzalez AG, Innis AC, Murr KA, Tucker MC, Pumilia CA, Myers PT, Ibe IK, Bergin PF, Greene ST, Powe SE, McKnight NH, Moss LK, Sambare TD, Mir HR, Sajid MI, Stang L, Dumpe JE, Denisiuk M, Pawlicki M, Sutherland M, Karunakar M, Serbin RP, Seymour RB, Churchill C. Author information: (1)OrthoVirginia/Liberty University, Lynchburg, VA. (2)Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC. (3)Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY. (4)Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA. (5)Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH. (6)Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN. (7)Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and. (8)Department of Orthopaedic Surgery, Prisma Health-Upstate, Greenville, SC. OBJECTIVES: To estimate representative outcomes of patients who underwent distal femur replacement (DFR) for distal femur fractures (DFFs). DESIGN: Retrospective Cohort Study. SETTING: Twelve academic trauma centers in the United States. PATIENT SELECTION CRITERIA: Adult patients who underwent DFR for native or periprosthetic DFF (OTA/AO 33A1.1-33C3.3) from 2010 to 2022 were included. Patients who underwent DFR for infectious, oncologic, and/or other indications besides fracture fixation were excluded. OUTCOME MEASURES AND COMPARISONS: The primary outcome was periprosthetic joint infection (PJI). Secondary outcomes included reoperation, 1-year mortality, and function. Outcomes were estimated using proportions and Kaplan-Meier curves with 95% confidence intervals (CI) and stratified by periprosthetic fracture with Fisher exact testing. RESULTS: One hundred seventy-three patients were included, with 130 (75%) having a periprosthetic DFF. The median age was 77 [interquartile range, 70-84] and the median final follow-up was 6 months [interquartile range, 2-14], with 146 women (84%) and several medical comorbidities (63% American Society of Anesthesiologists class III and 24% American Society of Anesthesiologists class IV). The rate of PJI was 5.8% (95% CI, 3.1%-10.5%). PJI was 2.3% for native compared with 6.9% for periprosthetic DFF ( P = 0.45). The reoperation rate was 16.6% (95% CI, 11.7%-23.0%), and the 1-year mortality was 27% (95% CI, 20%-35%). Fifty-five percent of patients returned to their baseline function (95% CI, 46.9%-62.1%). CONCLUSIONS: DFR for native and periprosthetic DFF was associated with a PJI rate of 5.8%. The 1-year mortality rate was 27.0%, and the reoperation rate was 16.6%. Fifty-five percent of patients returned to their baseline function. DFR can be considered as an option in cases of complex native and periprosthetic DFF, although surgeons should continue to counsel patients on the considerable risks associated with DFR when assessing treatment options. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BOT.0000000000003059