Current standard of care for distal femur fractures in Germany and Switzerland

Background: Distal femur fractures occur with an incidence of 4.5/100,000 and show a prevalence of 0.4%. Causes include low-impact trauma in older patients and high-impact trauma in younger patients without pre-existing medical conditions. The aim of this study was to perform a comprehensive evaluation of trauma mechanisms, trauma-promoting factors, comorbidities, medication history and type of surgical care to provide an overview of the causes of injury and the most appropriate therapeutic approach.Methods: In this multicenter cohort study a retrospective analysis of 229 patients who sustained a distal femur fracture between January 2011 and December 2020 was performed. Individual fracture patterns, fracture pre-disposing factors, concomitant disease profiles, medication history, treatment strategy and associated complications were analyzed.Results: 229 patients were included in the retrospective analysis. A total of 113-type 33 A, 50-type 33 B and 66 -type 33 C fractures were diagnosed, of whom 92% received a lateral locking plate osteosynthesis. There was a complication in 14.4% of all cases, of which 6.1% were attributable to infection. Significant risk factors for developing a complication were an increased BMI (29.9 +/- 8.5 kg/m(2); p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AO-C fractures (p < 0,016), specifically C2 fractures (p < 0,008).Conclusion: In this multicenter retrospective cohort study, lateral locking plate osteosynthesis was the method of choice and was selected in over 90% of cases, regardless of the fracture classification and risk factors. A complication rate of 14.4% emphasizes the necessary analysis of patient-and care-specific risk factors and a resulting adjustment of the therapy strategy. An increased BMI (29.9 +/- 8.5 kg/m(2); p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AO-C fractures (p < 0,016), specifically C2 fractures (p < 0,008) increase the risk of developing a complication and should prompt an early switch to a treatment strategy that provides more stability.

Automated summary

This study retrospectively analyzed data from 229 patients with distal femur fractures and found that lateral locking plate osteosynthesis was the main treatment method. The complication rate was 14.4% and was associated with increased BMI, increased fracture displacement, and specific fracture types.