Evaluation of Epidemiology and Post Surgical Complications after Supra Condylar Fractures of Distal Femur over Ten Years

Introduction:
Distal femoral fractures account for 1% of all fractures and 3-6% of adult femoral fractures and are associated with significant morbidity and mortality rates. Despite their relatively small percentage of all fractures, their prevalence is expected to increase due to the expected increase in the global geriatric population. In order to prepare properly for the not too distant future regarding the aging population, there is an increased need for information about these injuries.

Methods:
Over 10 years of hospital records including X-Ray and CT scans at the Rambam Health Care Campus were reviewed. 249 patients with distal femoral fractures were identified between January 2006 and March 2017. Five inappropriately coded cases, three non-fracture-related complicated cases and forty-eight pediatrics were excluded. Demographics and lifestyle, mechanism of injury, fracture classification (AO/OTA and Rorabeck), fixation technique, procedure complications and their treatment were collected and analyzed for the remaining 176 patients with 190 fractures.

Results:
The analysis shows that the patients average age is 53.8 (40.4 vs. 68.5 in high and low energy respectively) with 60 percent chance of being a woman (86 percent within low energy group). The average BMI was 27.6 and 36.2% of patients had associated underlying medical condition with majority of hypertension followed by diabetes melitus and heart conditions. Low energy group had significantly higher underlying medical conditions. Fracture patterns were 33-A (60.8%,) followed by 33-C (28%) and 33-B (11.1%). 99% underwent operative management with the most common technic to be locking plates (61%) followed by intra medullary nailing (27%). No difference has been found between management technics. Total complication rate was 10.5% with most common complication to be nonunion with 6.2%. Median healing time in non-complicated cases have found to be 195 days.

Conclusion:
The epidemiology of supra condylar - distal femoral fracture pattern, it’s management, complications and their treatment are described. The AO 33-A patterns was the most common. The fixation technique favored was multidirectional locking plates without obvious outcome advantage over intra modular nailing or other technics. The rate of non-union were similar to other studies but is still high and remains a challenging issue in treatment of distal femur fractures.