1008 Can the Nottingham Hip Fracture Score (NHFS) Predict Mortality After a Fragility Distal Femur Fracture?

Aim Fragility distal femur fractures (DFFs) are associated with comparable 30-day and 1-year mortality rates to fragility hip fractures. Since 2020/21 fragility DFFs have been included in the NICE Best Practice Tariff mechanism, with increasing focus on their outcomes. The Nottingham Hip Fracture Score (NHFS) is a validated risk stratification tool for predicting 30-day mortality after a fragility hip fracture. A NHFS >5 is associated with significantly increased risks of mortality. This study aims to assess the validity of the NHFS in predicting 30-day and 1-year mortality after a fragility DFF. Method A retrospective review of all fragility (patients >60-years-of-age) DFFs at a high-volume major trauma unit between October 2014 and December 2021 was performed. Native and periprosthetic DFFs were included. The NHFS was calculated as per the original description by Wiles et. al. Receiver operator characteristic curves (ROC) were constructed and the area under the curve (AUC) was used to assess the reliability to predict mortality. Results A total of 183 patients (with 73 periprosthetic DFFs) were included with an overall 2.7% 30-day and 24.6% 1-year mortality. The AUC for 30-day and 1-year mortality ROC showed outstanding and acceptable discrimination respectively (AUC 0.929 and 0.724). These results were maintained when native DFFs and periprosthetic DFFs were analysed individually. A NHFS >5 was associated with a significant increase in mortality risk at 30-day and 1-year (p<0.01). Conclusions The NHFS is accurate in predicting 30-day mortality after DFFs in both native and periprosthetic injuries, whilst providing a good indication to 1-year mortality.