Clinical outcomes and risk factors in the surgical treatment of distal femur fractures

Abstract Purpose Distal femoral fractures are rare but severe injuries with high complication rates, particularly in elderly or multimorbid patients. This study aimed to analyze complication profiles and identify risk factors for surgery-related and non-surgery-related complications following operative treatment. Methods A retrospective cohort study was conducted including all adult patients undergoing surgical treatment of distal femur fractures at a Level I trauma center between 2012 and 2018. Demographic, pre-operative, operative, and postoperative characteristics were analyzed. Risk factors were assessed using univariate statistics. Results A total of 56 patients with 60 distal femur fractures were included. Surgery-related complications occurred in 11.7% of cases, while non-surgery-related complications were observed in 58.3%. In univariate analysis, gender ( p = 0.004), age ( p = 0.014), BMI ( p = 0.006), osteoporosis ( p = 0.047), open fracture ( p < 0.001), high-energetic trauma (0.031) and time to surgery ( p = 0.024) were significant risk factors for surgery-specific complications. For non-surgery-related complications, need of an external fixator for primary surgical care and type of operation were significant risk factors in univariate analysis. In multivariable logistic regression analysis, need of an external fixator was the only significant risk factor for developing non-surgery-related complications (OR 9.9; p = 0.005). Conclusion Distal femoral fractures exhibit high complication rates. The need of external fixation was identified as independent statistically significant risk factor for non-surgery related complications (thromboembolic complications, pulmonary complications, urinary tract infection, anemia, etc.). Risk factors for surgery-specific complications could not be validated in multivariable analysis. Therefore, particular emphasis should be placed on thrombosis prevention and infection prevention in patients with an external fixator.