Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff

Islam Mubark, Amr Abouelela, Ahmed Genena, Abdallah Al Ghunimat, Islam Sarhan, Neil Ashwood, Islam Mubark, Amr Abouelela, Ahmed Genena, Abdallah Al Ghunimat, Islam Sarhan, Neil Ashwood

Abstract

Background and objectives The mortality after hip, proximal femur, fractures in elderly patients has steadily declined in the last decade in the United Kingdom as a result of implementing of multiple protocols focusing on prompt multidisciplinary pre- and post-operative optimization and reducing time to surgery. The pinnacle of these protocols is the development of the best practice tariff as an incentive program for hospitals that meet set criteria by the National Health Service (NHS) England in managing these injuries. Until the time of writing this paper, there was no parallel program for the management of fractures involving distal femur in the elderly. The aim of this study is to evaluate the outcomes of distal femur fractures in elderly patients against proximal femur fractures regarding post-injury mortality, the prevalence of surgical treatment and time delay till surgery. Methods A retrospective study of all patients above the age of 60 admitted to Queens Hospital Burton between 2010 and 2014 with fractures involving distal end of the femur. Patient data were assessed for demographic criteria, co-morbidities as per Charleston Comorbidities Index, type of management, time-lapse before surgery and 30-day, six-month and one-year mortality. Results were compared to an age-matched control group of patients with proximal femur fractures randomly selected during the same time window. Results The main demographic criteria such as age, gender, and Charleston Comorbidities Index were similar in both groups. There were more patients treated non-operatively in the distal femur group than in the proximal femur group (15% vs 4%). Time to surgery was statistically significantly longer in distal femur group compared to the proximal femur (49.130 hours vs 34.075 hours, P = 0.041). The mortality in distal femur group was higher at all times (9.68% at 30 days, 20.32% at six months and 34.41% at one year) when compared to that in the proximal femur group (6.99% at 30 days, 14.52% at six months, 21.51% at one year). Conclusion The distal femoral fractures showed higher mortality at 30 days, six months and one year compared to the proximal femur group. This could be partly influenced by the implementation of best practice tariff in the proximal femur fracture group reflected in less time to surgery, pre- and post-operative multidisciplinary approach and more frequent operative management.

Keywords: best practice tariff; distal femur fracture; elderly population; hip; mortality rate; neck of femur fractures; proximal femur fracture.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Mubark et al.

Figures

Figure 1. A box and whisker plot…
Figure 1. A box and whisker plot demonstrating the time to surgery in hours (Y-axis) in both fracture groups.
Figure 2. A bar chart demonstrating the…
Figure 2. A bar chart demonstrating the mortality rate as a percentage (Y-axis) in both groups at 30 days, 180 days and one year (X-axis).

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