High mortality rates after distal femur fractures in patients with end-stage renal disease.

Objectives: Hip fractures in patients with end-stage renal disease (ESRD) are associated with high mortality rates. The effect of ESRD on mortality after operative treatment of distal femur fractures is not known. Our hypothesis was that distal femur fractures carry a similar mortality risk and complication rate compared with proximal femur fractures in patients with ESRD.

Design: A retrospective database study using the United States Renal Data System registry.

Setting: Not applicable.

Patient Selection Criteria: Patients with ESRD who underwent operative fixation of proximal or distal femur fractures.

Outcome Measures And Comparisons: All-cause mortality risk and survival rates were calculated using Kaplan-Meier analysis. The results were adjusted for potential confounding variables including age, body mass index, sex, comorbidities, and duration of dialysis. Complications were analyzed with the χ test and one-way analysis of variance with the level of significance set at < 0.05.

Results: In patients with ESRD who sustained a proximal (6118) or distal (430) femur fracture, the mortality rate was, respectively, 50.1% and 45.8% at 1 year ( = 0.09), and 68.0% and 62.6% ( = 0.02) at 2 years. The adjusted risk of death was not different between ESRD patients with a proximal or a distal fracture (hazard ratio = 1.08, 95% confidence interval: 0.95-1.23, = 0.23). Rate of venous thromboembolic events at 90 days was similar between both groups (4.1% vs. 4.4%, = 0.72) as well as pneumonia (11.8% vs. 10.7%, = 0.48).

Conclusions: In patients with ESRD, mortality rates after distal femur fractures were high and similar to mortality rates after hip fractures.

Level Of Evidence: Level III; retrospective cohort study.