PRIMARY ARTHROPLASTY VERSUS OPEN REDUCTION AND INTERNAL FIXATION OF DISTAL FEMUR FRACTURES IN ELDERLY PATIENTS: A SYSTEMATIC REVIEW

Background: Distal femur fractures are the second most common type of femoral fracture in the elderly following proximal femoral fractures.it can be devastating injuries in the elderly, resulting in similar morbidity and mortality to what has been observed in geriatric femoral neck fractures. Although surgical fixation (SF) with either a locking plate or retrograde intramedullary nail (RIN) remains the most common treatment strategy, not all surgeons allow immediate postoperative weight bearing, and complications such as nonunion, malunion, knee stiffness and compromised function remain relatively common.
Aim of the work: To evaluate the outcome & complications of primary arthroplasty versus open reduction and internal fixation of fractures in distal femur in elderly patients.
Patients and Methods: We used a systematic review approach similar to that advocated by the Cochrane Collaboration, accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), appropriately modified for the epidemiological nature of our review objective and available data. We included a comprehensive search, transparent study selection and data extraction, risk of bias assessment, and synthesis of sufficiently similar data.
Results: Primary arthroplasty is becoming a promising option for treatment of distal femoral fractures in elderly patients as it provides many advantages over traditional methods of internal fixation such as early mobilization and avoiding non-union and knee stiffness, with shorter length of hospital stay and less cost on health-economics.
Conclusion: Primary arthroplasty is a reliable alternative to surgical fixation of acute distal femur fractures in geriatric population. This systematic review reinforces the potential value of a prospective randomized trial.