• Brett P Salazar, Aaron R Babian, Malcolm R DeBaun, Michael F Githens, Gustavo A Chavez, L Henry Goodnough, Michael J Gardner, and Julius A Bishop.
• Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA.
• J Orthop Trauma. 2021 Jan 1; 35 (1): 2-9.

ObjectivesThe management of geriatric distal femur fractures is controversial, and both primary distal femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies.Data SourcesPubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers.Study SelectionStudies evaluating complications in elderly patients treated for distal femur fractures with either immediate DFR or SF were included. Studies with mean patient age <55 years, nontraumatic indications for DFR, or SF with nonlocking plates were excluded.Data ExtractionTwo studies provided Level II or III evidence, whereas the remaining 28 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an incidence rate ratio.Data SynthesisTreatment failure was defined for both SF and arthroplasty as complications requiring a major reoperation for reasons such as mechanical failure, nonunion, deep infection, aseptic loosening, or extensor mechanism disruption. There were no significant differences in complication rates or knee range of motion between SF and DFR.ConclusionsSF and DFR for the treatment of geriatric distal femur fractures demonstrate similar overall complication rates. Given the available evidence, no strong conclusions on the comparative effectiveness between the 2 treatments can be definitively made. More rigorous prospective research comparing SF vs. DFR to treat acute geriatric distal femur fractures is warranted.Level Of EvidenceTherapeutic Level IV. See instructions for authors for a complete description of levels of evidence.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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