American Journal of Surgery · Oct 13, 2026

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

By Lutnick E, Ghanem D, Greenhill DA et al.

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.

doi.org/10.1016/j.amjsurg.2026.117239PubMed 42956439Populations