What question did this study set out to answer?

This study aims to evaluate the Nottingham Hip Fracture Score's effectiveness in predicting 30-day and one-year mortality after distal femur fragility fractures.

February 8, 2026Open Access

The Nottingham Hip Fracture Score is an accurate predictor of mortality at 30 days after fragility distal femur fractures

Key Points

This study aims to evaluate the Nottingham Hip Fracture Score's effectiveness in predicting 30-day and one-year mortality after distal femur fragility fractures.
Conducted a retrospective cohort study over 86 months in six units treating acute fragility fractures.
Calculated the Nottingham Hip Fracture Score for each case of distal femur fragility fractures.
Assessed 30-day and one-year mortality rates using hospital and primary care records.
30-day mortality rate was 7.1% for high-risk patients (NHFS > 5) and none for low-risk patients.
One-year mortality was 24.9%, with 6.4% in low-risk and 37.8% in high-risk groups.
Receiver operator characteristic analysis showed an area under the curve of 0.854 for 30-day mortality, indicating strong predictive power.

Abstract

Aims Fragility distal femur fractures have comparable mortality outcomes to fragility hip fractures. Increasing scrutiny is being placed on the perioperative management of these injuries to improve mortality and morbidity outcomes. A key pillar of preoperative consent is the explanation of adverse events associated with the underlying pathology and/or suggested treatment course. The Nottingham Hip Fracture Score (NHFS) is a validated tool used to predict mortality after a fragility hip fracture and has been shown to be predictive of mortality after fragility odontoid peg fractures. This study aims to assess the utility of the NHFS in predicting 30-day and one-year mortality after distal femur fragility fractures. Methods A retrospective cohort study of all consecutive fragility distal femur fractures treated surgically over an 86-month period at six units managing acute fragility fractures was performed. NHFS were calculated, with 30-day and one-year mortality ascertained from local hospital and primary care records. Patients were grouped as ‘high-risk’ of mortality with a NHFS > 5. Results Overall, 30-day mortality was 7.1% in the high-risk cohort (16/225), with no deaths identified in the low-risk cohort. Across both groups one-year mortality rate was 24.9%, with a 6.4% one-year mortality in the low-risk cohort (10/157) compared with 37.8% (85/225) in the high-risk cohort. Area under the curve analysis of receiver operator characteristic curves for 30-day mortality was 0.854 and 0.779 for one-year mortality. This demonstrated excellent predictive power at 30 days, diminishing slightly at one year. Conclusion The NHFS is an excellent predictor of 30-day mortality with reliability reducing at one year. A NHFS of 5 or more is associated with a deleterious outcome and can be used to inform discussions with patients and/or relatives regarding adverse outcomes. It can also identify patients with high mortality risk allowing for modifiable risk factors such as time to theatre to be further optimized. Cite this article: Bone Jt Open 2026;7(2):169–176.

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