Prevalence, clinicoradiological patterns and influencing factors of acute distal femur fractures among adults presenting with femur fractures at Mulago hospital

Abstract

Background: Distal femur fractures (DFFs) account for 3% to 6% of all femur fractures. They usually result from high energy trauma in the young and low energy trauma in the old. DFFs have a bimodal distribution based on age. Timely diagnosis and characterization of DFFs are important for planning definitive treatment. Currently, there is little data regarding the prevalence, the patterns, and the influencing factors of DFFs in Uganda. Aim: To estimate the prevalence, describe the patterns and the influencing factors of acute DFFs among adults presenting with femur fractures at Mulago Hospital (MNRH). Methods: This was a cross-sectional study of 251 consecutive patients with radiologically confirmed femur fractures admitted at MNRH between February to May 2022. Prevalence of DFFs was determined as a proportion of all patients with femur fracture enrolled in the study. Adults with acute DFF then underwent evaluation to determine the clinical and radiological patterns. Descriptive statistics was applied to characterize the patterns of DFFs. Logistic regression was used to determine the factors influencing the patterns of DFFs. Results: The prevalence of DFF was 24.6%.The prevalent role during road traffic crash (RTC) was a motorcycle rider (39.2%). An overwhelming proportion (96.8%) of DFFs resulted from high energy mechanisms. We found more open injuries (54.8%). Gustilo-Anderson IIIA (71.9%) were the commonest pattern of open DFFs. AO type 33C3 (48.8%) was the predominant radiological pattern. RTC victims had 66% lower risk of sustaining an open DFF than fall from height victims. Pedestrians were 33 times at risk of sustaining an open DFF compared to motorcycle riders. Conclusion: The prevalence of DFFs among adults presenting with femur fractures at MNRH is high. Most DFFs are due to high energy mechanisms. Open and complex articular injuries are common among the young male population. Among DFFs resulting from high energy mechanisms, those who fell from height (1meter and above) and pedestrians were more likely to sustain an open injury.