Distal Femoral Replacement Versus Open Reduction and Internal Fixation in Elderly Distal Femur Fractures: A Systematic Review and Meta-Analysis

Distal femur fractures are a major cause of morbidity and mortality among older adults, often complicated by osteoporosis and comorbidities that hinder recovery. This systematic review and meta-analysis compared distal femoral replacement (DFR) and open reduction internal fixation (ORIF) for such fractures in elderly patients. A comprehensive search of PubMed, Scopus, Google Scholar, and the Cochrane Library identified six comparative studies including 688 patients. Pooled data showed a trend toward fewer reoperations with DFR (odds ratio (OR): 0.44, 95% confidence interval (CI): 0.16-1.21) and similar complication rates between DFR and ORIF (OR: 0.96, 95% CI: 0.37-2.54). Mortality was significantly lower in patients treated with DFR (OR: 0.32, 95% CI: 0.12-0.84). These findings suggest that DFR may reduce mortality and the need for revision surgery without increasing complications, supporting its consideration as an alternative option for elderly patients with distal femur fractures.