Distal Femoral Replacement for Fragility and Periprosthetic Fractures in a District General Hospital: A Five-Year Retrospective Cohort Study

Background Distal femur fractures in elderly or comorbid patients pose a significant challenge due to poor bone stock, complex fracture morphology, and limited tolerance for prolonged immobility. Distal femoral replacement (DFR) is increasingly utilised as an alternative to internal fixation, but evidence for its use outside tertiary centres remains limited. Methods We retrospectively reviewed all DFR procedures for trauma indications at a district general hospital (DGH) over a five-year period (2019-2024). Patient demographics, perioperative variables, infection rates, transfusion requirements, length of stay, and mortality were analysed. Results Twenty-four patients underwent DFR for non-oncological trauma, including native and periprosthetic distal femoral fractures. Surgical site infections (SSIs) occurred in 25% (n = 6) of cases, with 16.7% superficial and 8.3% deep infections. Median time to surgery was three days. A total of 83.3% of patients required blood transfusions. Median length of stay was 17.5 days. One-year mortality was 16.7%, and 90-day mortality was 8.3%. All discharged patients returned to their own homes. Conclusion DFR can be safely delivered in a DGH setting with infection and mortality rates comparable to published data from tertiary centres. Early surgery and full weight-bearing rehabilitation are achievable and may contribute to functional recovery in this vulnerable cohort.