Beyond mechanism: comparable complication rates in high- and low-energy distal femoral fractures suggest complex risk interplay

Background. Distal femoral fractures traditionally present in two distinct populations: young males with high-energy trauma and elderly females with low-energy injuries. Despite inherent differences between these groups, direct outcome comparisons remain limited.

The aim of the study — to compare complication rates between surgically treated high- and low-energy distal femoral fractures and to assess whether injury mechanism independently influences outcomes.

Methods. A retrospective review of surgically treated distal femoral fractures at a single center over a decade was conducted. Cases were categorized into high- and low-energy mechanisms. Patient demographics, comorbidities, fracture characteristics, fixation methods, and annual incidence were analyzed. Primary outcomes included nonunion, infection, and hardware failure.

Results. A total of 162 cases were analyzed, with an overall complication rate of 12.3%: nonunion (6.8%), infection (3.1%), and hardware failure (2.5%). Complication rates were comparable between high- and low-energy groups (p = 0.551).

Conclusions. Despite distinct demographic profiles and injury mechanisms, complication rates were similar between groups, suggesting a complex balance of risk factors. This finding challenges the assumption that injury mechanism predicts outcomes and emphasizes the importance of personalized perioperative care addressing patient-specific risk factors rather than injury mechanism alone.