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

Abstract

Background Patients with distal femur fractures are associated with mortality rates comparable to neck of femur fractures. Identifying high-risk patients is crucial in terms of orthogeriatric input, pre-operative medical optimisation and risk stratification for anaesthetics. The Nottingham Hip Fracture Score (NHFS) is a validated predictor of 30-day mortality in neck of femur fracture patients. In this study, we aim to investigate and evaluate the suitability of the NHFS in predicting 30-day as well as one-year mortality of patients who have sustained distal femur fractures. Methods Patients admitted to a level 1 major trauma centre with distal femur fractures were retrospectively reviewed between June 2012 and October 2017. NHFSs were recorded using parameters immediately pre-operatively. Results Ninety-one patients were included for analysis with a mean follow-up of 32 months. The mean age was 69, 56 (61%) patients were female, 10 (11%) were open fractures and 32 (35%) were peri-prosthetic fractures with 85% of patients being surgically managed. Forty-one patients were found to have an NHFS >4. Overall mortality at 30 days was 7.7% and at 1 year was 21%. Patients with an NHFS of ≤4 had a lower mortality rate at 30 days of 6% compared with those with >4 at 9.8% (p=0.422). On Kaplan-Meier plotting and log-rank test, patients with an NHFS of >4 were associated with a higher mortality rate at 1 year at 36.6% compared to patients with an NHFS of ≤4 at 8% (p=0.001). Conclusion NHFS is a promising tool not only in neck of femur fractures but also distal femur fractures in risk-stratifying patients for pre-operative optimisation as well as a predictor of mortality.

Keywords: distal femur fracture; lower extremity trauma; nottingham hip fracture score; perioperative mortality; pre-operative management.

Figure 1. The Kaplan-Meier curve showing 30-day postoperative mortality in patients who have sustained a distal femur fracture.

NHFS, Nottingham Hip Fracture Score.

Figure 2. The Kaplan-Meier curve showing one-year postoperative mortality in patients who have sustained a distal femur fracture.

NHFS, Nottingham Hip Fracture Score.

Figure 3. The Kaplan-Meier curve showing postoperative mortality between two groups: conservatively managed patients versus surgically managed patients in age ≥65 years.