Abstract：
OBJECTIVE: This cohort study aimed to describe the functional outcomes, complications, and mortality of patients over 65 with acute distal femur fractures treated with open reduction and internal fixation (ORIF) or distal femoral replacement (DFR).
METHODS: We retrospectively analyzed all patients older than 65, operated consecutively for a distal femur fracture treated with ORIF or DFR. We included 75 patients (9 33A, 5 33B, and 61 33C AO/OTA fractures), 55 treated with ORIF, and 20 with DFR. We used Parker\'s mobility index (PMI) to assess functional outcomes at 1, 3, and 12 months and study closure. We analyzed complications, reoperations, and mortality at 30 days, one year, and at the end of the study.
RESULTS: The PMI was significantly higher in the DFR group at months 1 (p = 0.023) and 3 (p = 0.032). We found no significant differences between cohorts at one year and the end of follow-up. Postoperative complications were significantly more frequent in the ORIF group (38.10% vs. 10%, p = 0.022). Reoperations were similar in both cohorts (p = 0.98). Mortality at one month was 4% and 20% at one year, and at the end of follow-up, there were no significant differences between groups.
CONCLUSIONS: The outcomes of this study suggest that DFR offers a faster functional recovery with lower complication rates than those treated with ORIF. Additionally, both options have similar reoperation and mortality rates. Appropriately designed studies are needed to define the best treatment strategy for this type of patient.
METHODS: We retrospectively analyzed all patients older than 65, operated consecutively for a distal femur fracture treated with ORIF or DFR. We included 75 patients (9 33A, 5 33B, and 61 33C AO/OTA fractures), 55 treated with ORIF, and 20 with DFR. We used Parker\'s mobility index (PMI) to assess functional outcomes at 1, 3, and 12 months and study closure. We analyzed complications, reoperations, and mortality at 30 days, one year, and at the end of the study.
RESULTS: The PMI was significantly higher in the DFR group at months 1 (p = 0.023) and 3 (p = 0.032). We found no significant differences between cohorts at one year and the end of follow-up. Postoperative complications were significantly more frequent in the ORIF group (38.10% vs. 10%, p = 0.022). Reoperations were similar in both cohorts (p = 0.98). Mortality at one month was 4% and 20% at one year, and at the end of follow-up, there were no significant differences between groups.
CONCLUSIONS: The outcomes of this study suggest that DFR offers a faster functional recovery with lower complication rates than those treated with ORIF. Additionally, both options have similar reoperation and mortality rates. Appropriately designed studies are needed to define the best treatment strategy for this type of patient.
摘要：
目的：这项队列研究旨在描述功能结局，并发症,采用切开复位内固定（ORIF）或股骨远端置换术（DFR）治疗的65岁以上急性股骨远端骨折患者的死亡率。
方法：我们回顾性分析了所有年龄在65岁以上、连续接受ORIF或DFR治疗的股骨远端骨折手术的患者。我们纳入了75例患者(933A，533B,和6133CAO/OTA骨折），55用ORIF治疗，和20与DFR。我们使用Parker的流动性指数（PMI）评估1、3和12个月时的功能结局和研究结束。我们分析了并发症,重新操作,和30天的死亡率，一年,在研究结束时。
结果：DFR组的PMI在第1个月（p=0.023）和第3个月（p=0.032）时明显升高。我们在一年和随访结束时发现队列之间没有显着差异。ORIF组术后并发症明显增多(38.10%vs.10%,p=0.022)。两组的再手术相似（p=0.98）。一个月死亡率为4%，一年死亡率为20%，在后续行动结束时，组间无显著差异.
结论：这项研究的结果表明，与ORIF治疗相比，DFR提供了更快的功能恢复和更低的并发症发生率。此外,两种选择的再手术率和死亡率相似.需要适当设计的研究来确定此类患者的最佳治疗策略。
方法：我们回顾性分析了所有年龄在65岁以上、连续接受ORIF或DFR治疗的股骨远端骨折手术的患者。我们纳入了75例患者(933A，533B,和6133CAO/OTA骨折），55用ORIF治疗，和20与DFR。我们使用Parker的流动性指数（PMI）评估1、3和12个月时的功能结局和研究结束。我们分析了并发症,重新操作,和30天的死亡率，一年,在研究结束时。
结果：DFR组的PMI在第1个月（p=0.023）和第3个月（p=0.032）时明显升高。我们在一年和随访结束时发现队列之间没有显着差异。ORIF组术后并发症明显增多(38.10%vs.10%,p=0.022)。两组的再手术相似（p=0.98）。一个月死亡率为4%，一年死亡率为20%，在后续行动结束时，组间无显著差异.
结论：这项研究的结果表明，与ORIF治疗相比，DFR提供了更快的功能恢复和更低的并发症发生率。此外,两种选择的再手术率和死亡率相似.需要适当设计的研究来确定此类患者的最佳治疗策略。
