Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: Insights from the National Trauma Data Bank

Sung Huang Laurent Tsai; Tung-Yi Lin; Eric H Tischler; Kuo-Hsien Hung; Chien-Hao Chen; Greg Michael Osgood; Tsai-Sheng Fu; Chun-Yi Su

doi:10.1016/j.injury.2021.04.023

Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: Insights from the National Trauma Data Bank

Injury. 2021 Jul;52(7):1903-1907. doi: 10.1016/j.injury.2021.04.023. Epub 2021 Apr 20.

Authors

Sung Huang Laurent Tsai¹, Tung-Yi Lin², Eric H Tischler³, Kuo-Hsien Hung⁴, Chien-Hao Chen⁴, Greg Michael Osgood⁵, Tsai-Sheng Fu⁴, Chun-Yi Su⁴

Affiliations

¹ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
² Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan. Electronic address: ross_1222@hotmail.com.
³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States.
⁴ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
⁵ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, United States.

PMID: 33896612
DOI: 10.1016/j.injury.2021.04.023

Abstract

Introduction: The comparison of mortality and morbidity between distal femur (DF) and hip fracture in the old age is rarely reported in the literature. We aim to analyze a nationwide database among the elderly to compare the outcomes between hip fractures and distal femur fractures in the United States.

Materials and methods: A retrospective analysis of the National Trauma Data Bank was queried between 2007-2014 to identify distal femur (DF) and hip fracture patients greater than 65 years of age. Outcomes analyzed included in-hospital mortality, total hospital length of stay(LOS), intensive care unit length of stay(ICU-LOS), length of ventilation use and hospital discharge disposition. Multivariable regression models were performed to adjust for potential confounders. Statistical significance was established at p < 0.001.

Results: 26,325 (10.1%) and 233,213 (89.9%) patients reported a diagnosis of DF and hip fracture, respectively. The inpatient mortality rate was significantly higher in the distal femur fracture group (8.3% vs. 6.7%), with significantly longer LOS (7.87 vs. 6.65), ICU-LOS (1.50 vs. 0.73), and required ventilation days (0.74 vs. 0.27). Multivariable analyses demonstrated that hip fracture patients had a lower mortality (adjusted odds ratio [aOR], 0.80; 95% CI [0.76, -0.85]; p < 0.001), shorter LOS ([aOR], -0.31; 95% CI [-0.39, -0.23]; P < 0.001), and more likely to be discharged home ([aOR], 0.88; 95% CI, 0.85, 0.91; P < 0.001, compared to DF fracture patients.

Conclusion: After adjusting for potential factors, DF fracture patients have a significantly higher mortality, longer LOS, and less likely to be discharged home compared to hip fractures among the elderly. These results may suggest clinicians and caregivers for closely monitoring of clinical conditions for these patients.

Level of evidence: III.

Keywords: Database; Distal femur fracture; Epidemiology; Hip fracture; Osteoporosis.

MeSH terms

Aged
Femur
Hip Fractures*
Humans
Length of Stay
Patient Discharge
Retrospective Studies
United States / epidemiology