Outcomes following elderly femoral shaft fractures: A GOLD-FEM (geriatric outcomes and long-term data on FEMoral fractures) multicenter study.

E. Lutnick D. Ghanem D. Greenhill Niloofar Dehghan Brianna R. Fram Andrew T. Chen Adam D. Bitterman Benjamin E. Hershfeld Mark Anders Nicholas Frappa Matthew W. Kavolus S. Becher S. Guthrie M. Abbas Kashif Javid Ryan Will Lauren M. Tatman Juanita M. Velasco-Castro Erik Rundquist Kevin G. Valdes Douglas W. Lundy Zachary L. Telgheder R. Turner Alison Buseck Katherine Lutz M. Pagan B. Shafiq Rachel B. Sotsky Samalya Thenuwara Shi-Ming Xie Motasem Salameh Joshua G. Sanchez Rachel B. Seymour Sadie Charles Calame Michael T. Talerico Jarrod E. Dumpe Adithi Shyam P. Tornetta Francesca Simeone-Tocci J. Adams Raymond L. Kitziger Sabrina Salley William Corns Kyle J. Adams Kyle J. Jeray A. Ghildiyal Demetri A. Monovoukas David A. Forsh Lisa K. Cannada

Oct 2026 · American Journal of Surgery · Vol 263, pp. 117239 · 0 citations · 23 references

Medicine

Abstract

Purpose

Elderly femoral shaft fractures present unique challenges due to physiologic vulnerability and medical comorbidity, yet the perioperative outcomes associated with these injuries remain poorly defined.

Methods

A multicenter retrospective study of patients 60-90 years with an isolated, operatively managed femoral shaft fracture was completed. Pathologic, intra-articular, and peri-implant fractures were excluded. Perioperative outcomes, medical and surgical complications, and mortality were analyzed.

Results

432 patients averaging 73.7 years old met inclusion criteria. 74% were female and 85% had a low-energy mechanism. Fixation consisted of intramedullary nail (91%), plate (3%), or combined nail-plate constructs (6%). Two-thirds of the cohort experienced at least one complication, and the reoperation rate was 23.2%. At final follow-up (mean 24 weeks), the mortality rate was 18.2%, and 16% had not achieved radiographic union.

Conclusion

Geriatric femoral shaft fractures, even in isolation, carry high morbidity and mortality. Patient counseling and perioperative management should acknowledge these risks.

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