• OBJECTIVES
    • To compare Healthy Days At Home (HDAH90) within 90 days of hospital discharge after single implant (SI) or dual implant (DI) fixation in geriatric distal femur fractures.
  • METHODS
    • Design: Retrospective Review.
  • SETTING
    • Three Level I Trauma Centers.
  • PATIENT SELECTION CRITERIA
    • Geriatric (age ≥ 60 years) distal femur fracture patients (OTA/AO 33 A, C) operatively treated with SI (lateral plate or retrograde intramedullary nail (IMN)) or DI (two plates or plate and IMN) between January 2018-January 2024 were included.
  • OUTCOME MEASURES AND COMPARISONS
    • The primary outcome was HDAH90, which was calculated from date of surgery to 90 days follow-up and accounted for days after mortality, skilled nursing facilities (SNF), readmissions, and secondary surgeries. HDAH90, days at SNF, 90-day readmission, 90-day mortality, return to baseline ambulatory status at 180-days, and length of hospitalization were compared between patients with SI or DI. A binary logistic multivariate regression was used to compare outcomes while controlling for age, gender, dependence on assistive device, periprosthetic fracture, and post-operative weight bearing status.
  • RESULTS
    • The 229 SI patients were 2 years younger than the 70 DI patients (73 vs. 75 years, p=0.03). The DI cohort had more female patients (82.9% vs 70.7%, p=0.044), and more periprosthetic fractures (55.7% vs. 35.4%, p=0.002). There was no other demographic, fracture characteristic, or preoperative ambulatory differences between groups (p>0.05). Following regression analysis, DI patients had greater HDAH90 (55 vs 45, p=0.024) and fewer days at SNF (22 vs 32, p=0.026) than SI patients. There were no differences in 90-day readmission (DI odds 1.36, p=0.353), 90-day mortality (DI odds 0.94 p=0.935), return to baseline ambulatory status at 180 days (DI 1.64, p=0.433), and length of hospitalization (DI 10 days vs SI 9 days, p=0.579).
  • CONCLUSIONS
    • Geriatric patients treated with dual implants for distal femur fractures experienced an additional 10 Healthy Days at Home90 as compared to those treated with single implants. Given that a 10-day difference is clinically significant in geriatric fractures for Healthy Days at Home90, using dual implant constructs may represent an improvement in care for distal femur patients.
  • LEVEL OF EVIDENCE
    • III, prognostic.