# Clinical and patient-reported outcomes of distal femur fracture fixation in adults aged 18–50 years

## TL;DR

This study examines the outcomes of surgery for distal femur fractures in young adults, finding that some patients need additional surgery and have slightly reduced physical function compared to the general population.

## Contribution

The study provides new insights into the long-term patient-reported outcomes and reoperation rates following distal femur fracture fixation in young adults.

## Key findings

- 13% of patients required reoperation for nonunion and 3.5% for fracture-related infection.
- Physical function scores were lower than the reference population, while depression and anxiety scores were similar.
- Older age and higher BMI at injury were associated with worse physical function outcomes.

## Abstract

To describe nonunion and fracture-related infection (FRI) rates and patient-reported outcomes following operative treatment for distal femur fractures in young patients.

We retrospectively identified all patients (aged 18–50) who were operatively treated for a distal femur fracture between 2006 and 2023 with ≥ 3-month clinical follow-up at two Level 1 Trauma Centers. Outcomes included reoperation for nonunion and FRI; and PROMIS physical function (PF), depression, and anxiety (reference population mean: 50). Multiple linear regression was performed to identify factors associated with PROMIS-PF.

Eighty-six patients met inclusion criteria. The median age was 34 years, 71% were male, 42% had an open fracture, and for 38 patients PROMIS scores were collected at an average of 9.8 years after treatment. Eleven patients (13%) required reoperation for nonunion and 3 (3.5%) for FRI. Median PROMIS-PF was 47.0 (IQR: 41.2–52.4), depression 45.8 (IQR: 38.9–53.6), and anxiety 46.7 (IQR: 39.5–60.5). PROMIS-PF was lower than the reference population score (p < 0.05). Increased age (1-year; ß: − 0.39; 95%CI: − 0.62 to − 0.17; p < 0.001) and BMI (1-unit; ß: − 0.59; 95%CI: − 0.98 to − 0.20; p = 0.004) at time of injury were associated with worse PROMIS-PF scores and longer follow-up (1-year; ß: 0.79; 95% CI: 0.27 to 1.3; p = 0.004) with better scores.

One in 8 young patients with a distal femur fracture underwent reoperation for nonunion and one in 33 for FRI. Physical function scores were marginally lower than the reference population, whereas depression and anxiety scores were similar. The finding that physical function scores were more influenced by baseline patient factors than injury characteristics is important for prognostication and patient education. These results should be interpreted in the context of the small sample size, and future research with larger cohorts is needed to confirm these findings and better understand long-term functional outcomes in young patients following treatment of distal femur fractures.

The online version contains supplementary material available at 10.1007/s00590-025-04392-4.