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Article Title

Risk Factors for Reoperation Following Operative Fixation of Distal Femur Fractures: A Report of 73 Consecutive Cases

Abstract

Introduction: Various factors including patient demographics, fracture types, and fixation methods can affect the outcomes of distal femur fractures. This study aimed to analyze the risk factors for reoperation after operative fixation of these fractures. Methods: This was an institional review board (IRB) approved retrospective study of extra-articuilar, partial articular, and complete articular distal femur fractures treated with operative fixation at a Level I trauma center between 2008 and 2018. The study included a consecutive series of adult patients operatively treated for a distal femur fracture. The primary outcome was reoperation rate due to infection, non-union, or implant failure. Periprosthetic distal femur fractures were excluded. Statistical analysis used logistic regression. Results: This study included 73 patients; 70 (96.0%) were closed fractures, and 3 were open. The average age at time of fracture was 61.6 years ± 18.2 years old. Fixation methods included external fixation (3 out of 73), intramedullary nailing (8 out of 73), and locking plates (62 out of 73). Of the 73 cases, 71 cases required nail alone, while two cases required nail and plate combination. The median follow-up time after operation was 14.2 months (InterQuartile Range, (IQR): 3.0, 17.2). Infection was reported in 6 out of 73 (8.0%) patients; reoperations occurred in 11 out of 73 (15.0%) patients. Age at presentation was the only patient demographic to negatively impact the odds of reoperation (odds ratios (OR) = 0.96, 95.0%, confidence interval (CI): [0.92, 0.99]). Patiens who sustained motor vehicle accidents (MVA) were 4.6 times more likely to require reoperation when compared to falls as the mechanism of injury (P-value = 0.032). Additionally, open fracture type was 13.6 times more likely to require reoperation as compared to the closed fracture type (P-value = 0.041). Using bone grafts decreased the risk of additional surgery as there was 80.0% less chance of requiring reoperation (OR = 0.2, 95.0% CI: [0.05, 0.77], P-value = 0.019). This was the only operational characteristic to impact the odds of reoperation. Conclusion: Several risk factors may lead to reoperation following operative fixation of distal femur. This study found that age of presentation, mechanism of injury, type of fracture including Arbeitsgemeinschaft für Osteosynthesefragen, (AO)/Orthopedic Trauma Association, (OTA) classification and bone graft use can all impact the odds of reoperation. While some of these factors cannot be controlled, having a better understanding of the risk factors associated with reoperation of distal femur fractures can lead to better management of these fractures by orthopaedic surgeons.

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