Differential complication risks in diabetic and non-diabetic geriatric patients following distal femur fracture surgery.

backgroundCurrent literature is limited regarding the impact of diabetes mellitus (DM) on short- and long-term postoperative complications following distal femur (DF) fracture surgery in geriatric patients. Although DM is a known risk factor for adverse outcomes following hip fracture and lower-extremity arthroplasty, large-scale data specific to DF fractures, which pose distinct fixation, weight-bearing, and healing challenges, remain limited. This study evaluates short- and long-term postoperative complication rates among geriatric patients undergoing operative treatment for DF fractures, comparing those with and without DM.

methodsUsing a nationally representative multi-institutional database, we conducted a retrospective analysis of patients aged ≥ 65 years who underwent DF fracture surgery between January 2012 and January 2022. Patients were categorized as having DM or not, and propensity score matching controlled for demographic and comorbidity differences. A subgroup analysis stratified diabetic patients into complicated and uncomplicated DM to assess whether disease severity modified risk. Follow-up periods were 6 months, 1 year, and 3 years.

resultsA total of 9390 patients were matched into each cohort. Patients with DM had significantly higher risks of myocardial infarction, transfusion, acute kidney failure, glomerular disease, pneumonia, mortality, cardiac arrest, and wound dehiscence across all follow-up intervals. Surgical site infection was more frequent in the DM cohort at 6-month and 1-year follow-up but did not reach statistical significance at 3 years. No significant differences were observed in deep vein thrombosis, pulmonary embolism, hematoma, DF nonunion, or DF malunion. In the subgroup analysis, patients with complicated DM showed higher rates of major complications, including acute kidney failure and myocardial infarction, compared with matched patients with uncomplicated DM.

conclusionsGeriatric patients with DM were observed to have significantly higher rates of medical and infectious complications following distal femur fracture surgery compared with matched non-diabetic patients. These findings identify DM, and particularly complicated DM, as an important risk marker and may warrant consideration of enhanced perioperative co-management. Because this is a retrospective observational study, findings represent associations rather than causal relationships; prospective and interventional studies are needed to clarify modifiable factors in geriatric patients with DM undergoing DF fracture surgery.