From the Guidelines
A distal femoral fracture can be considered a fragility fracture, especially in older adults with underlying osteoporosis, as it often results from low-energy trauma due to compromised bone strength. Fragility fractures, including those at the distal femur, are associated with significant morbidity and mortality, and their occurrence is a strong predictor of future fractures [ 1 ]. The management of distal femoral fragility fractures typically involves surgical fixation, followed by a rehabilitation program, and it is crucial to address the underlying osteoporosis to prevent future fractures [ 1 ].
Key Considerations
- Fragility fractures occur from low-energy trauma that would not normally cause a fracture in healthy bone, such as a fall from standing height or less [ 1 ].
- Distal femoral fractures in older adults often result from minor trauma due to underlying bone weakness [ 1 ].
- These fractures can be challenging to treat due to poor bone quality, comminution, and biomechanical stresses in the area [ 1 ].
- Patients with distal femoral fragility fractures should undergo osteoporosis evaluation and treatment to prevent future fractures [ 1 ].
Osteoporosis Evaluation and Treatment
The underlying mechanism of fragility fractures involves age-related bone loss, decreased bone mineral density, and altered bone microarchitecture that compromises bone strength and increases fracture risk even with minimal trauma [ 1 ]. Treatment may include calcium and vitamin D supplementation, along with medications like bisphosphonates, denosumab, or teriparatide to prevent future fractures [ 1 ]. It is essential to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than 2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density [ 1 ].
From the Research
Definition of Fragility Fracture
A fragility fracture is a type of fracture that occurs when a bone breaks due to a low-energy trauma, such as a fall from a standing height or less, in an individual with weakened bones, often due to osteoporosis.
Distal Femoral Fracture as a Fragility Fracture
- Distal femoral fractures can be considered fragility fractures in certain cases, particularly in the elderly population, where they often occur due to osteoporosis 2.
- The study by 2 mentions that distal femoral fractures account for 3-6% of all femoral fractures, with a similar demographic as patients suffering from proximal femoral fractures, which are commonly considered fragility fractures.
- Another study by 3 notes that distal femoral fractures can occur as osteoporotic fractures in the elderly population.
- However, it's essential to note that distal femoral fractures can also occur due to high-energy trauma in younger individuals, which would not be considered fragility fractures 3, 4, 5.
Characteristics of Distal Femoral Fractures
- Distal femoral fractures can be challenging to manage due to poor bone quality, intra-articular extension, and significant comminution 2, 4, 5.
- The treatment of distal femoral fractures often requires surgical intervention, with goals including restoration of articular congruity, anatomical length, rotation, and axial alignment 3, 4, 5, 6.
- Early mobilization is crucial in the treatment of distal femoral fractures to reduce morbidity and mortality, particularly in the elderly population 2, 5, 6.