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

• Published in: Curēus (Palo Alto, CA) Vol. 13; no. 10; p. e19139
• Main Authors: Archunan, Maheswaran W, Subhash, Sadhin, Attwood, Joseph, Kumar, Siddhant, Choudhry, Nameer, Fountain, James, Liew, Ignatius
• Format: Journal Article
• Language: English
• Published: Palo Alto Cureus Inc 30-10-2021; Cureus
• Subjects: Accuracy; Age; Fractures; Hemoglobin; Hip joint; Internal Medicine; Mortality; Orthopedics; Patients; Prostheses; Trauma; United Kingdom > UK
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.19139

BackgroundPatients 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.MethodsPatients 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.ResultsNinety-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).ConclusionNHFS 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.