Does Nottingham Hip Fracture Score Predict Mortality in Distal Femoral Fracture Patients?

Ignatius Liew, Joseph Attwood, Siddhant Kumar, Nameer Choudry, James Fountain

Background: Patients with distal femoral fractures are associated with similar high rates of mortality to neck of femur fractures. Identifying high risk patients are crucial in pre-operative medical optimisation, risk stratification for anaesthetics and orthogeriatric input. Nottingham Hip Fracture Score (NHFS) has been validated as a predictor of mortality in neck of femur fracture patients, especially in those with score of ≥5 as high risk. We investigated the validity of NHFS in predicting 1 year mortality of patients sustaining distal femoral fractures.

Methods: All patients admitted to a level 1 major trauma centre with distal femoral fractures were retrospectively reviewed between June 2012 and October 2017. NHFS were recorded using parameters immediately pre-operatively.

Results: 92 patients were included for analysis with mean follow-up of 32 months, mean age of 69 (range 16-101). 56 (61%) of patients were female, 10 (11%) were open fractures and 32 (35%) were periprosthetic fractures with 77 (85%) patients surgically managed. 41 patients were found to have NHFS ≥5. Overall mortality at 30 days was 7% and 1 year was 33%. Patients with NHFS of <4 had a higher survival rate at 30 days (96% vs 90%) and at 1 year (74% vs 49%, p=0.002) when compared with those of higher risk (NHFS ≥5) On Kaplan-Meier plotting and Log-Rank test, patients with a NHFS of ≥5 were associated with a higher mortality (p=0.0001).

Conclusion(s): NHFS can be used to stratify distal femur fracture patients, identifying those with high risks of mortality. NHFS is a validated tool not only in hip fracture but also distal femoral fractures in risk stratifying patients for pre-operative optimisation as well as predictor of mortality at 30 days and 1 year.