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Fractures of the lower extremity lead to lower survivorship in elderly
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BALTIMORE — The age-adjusted Charlson Comorbidity Index could serve as a useful tool to predict survival after distal femur fractures in elderly patients, according to a study presented here.
Philipp N. Streubel, MD, presented his group’s findings at the 2010 Annual Meeting of the Orthopaedic Trauma Association, here.
The researchers also noted that dementia, heart failure, advanced renal disease, a history of malignancy and fractures occurring around a previous total knee arthroplasty lead to reduced survival, and that a surgical delay of greater than 4 days may significantly increase 6-month and 1-year mortality risks.
“The major goal of our study was to calculate mortality rates in elderly patients with low-energy distal femur fractures, and compare them with those of an age and comorbidity-matched cohort of hip fracture patients,” Streubel told Orthopedics Today.
Study methods and findings
Streubel’s group assessed 92 consecutive patients older than 60 years with low-energy supracondylar femur fractures treated between 1999 and 2009. Patient, fracture, and treatment characteristics, Streubel said, were extracted from operative records, charts, and radiographs. Mortality data were obtained from the Social Security Death Index.
The researchers found that the age-adjusted Charlson Comorbidity Index and a previous total knee arthroplasty were independent predictors for decreased survival rates. Further, congestive heart failure, dementia, moderate to severe renal disease and history of malignant tumor were found to lead to shorter survival times.
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Images: Streubel PN |
The dangers of delay
Streubel said his group noted that patients who underwent surgery more than 4 days after admission fared worse when compared to patients operated on within 48 hours.
“We found that patients operated 4 days or more after admission had a seven-fold mortality risk compared to that of patients undergoing surgery within 48 hours after admission,” Streubel said. “Similarly, mortality at 1 year was almost eight times higher when surgery was performed 4 days after admission.”
“However, according to multivariable analysis, delay to surgery could not be identified as an independent predictor for mortality,” he added. “Furthermore, delayed patients were slightly sicker, suggesting that surgical delay is more likely a confounding variable for mortality, and poor health more likely its cause.”
Streubel said special care should be taken in the effort to prevent complications related to prolonged immobility, and geriatric patients with fractures of the hip and distal femur may benefit from an interdisciplinary treatment approach.
“Our study showed a striking similarity in mortality rates at 30 days, 6 months and 1 year after surgery, among geriatric patients with distal femur fractures and those with fractures of the hip,” Streubel said. “This finding suggests that fractures of the lower extremity may in general affect survivorship in the elderly population.”
Streubel added that additional studies are needed to “establish whether other fractures of the lower extremity — such as those involving the metaphyseal segments and joint surfaces of the tibia —have a similar effect.” – by Robert Press
References:
- Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res. 2010 Sep 10. [Epub ahead of print].
- Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Paper #46. Presented at the 2010 Annual Meeting of the Orthopaedic Trauma Association. Oct. 13-16, 2010. Baltimore.
- Philipp N. Streubel, MD, can be reached at philipp.n.streubel@vanderbilt.edu. He has no direct financial interest in any products or companies mentioned in this article.
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