Archunan Maheswaran W, Subhash Sadhin, Attwood Joseph, Kumar Siddhant, Choudhry Nameer, Fountain James, Liew Ignatius
Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, GBR.
Trauma and Orthopaedics, Aintree University Hospital, Liverpool, GBR.
Cureus. 2021 Oct 30;13(10):e19139. doi: 10.7759/cureus.19139. eCollection 2021 Oct.
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.
股骨远端骨折患者的死亡率与股骨颈骨折患者相当。识别高危患者对于老年骨科干预、术前医疗优化以及麻醉风险分层至关重要。诺丁汉髋部骨折评分（NHFS）是股骨颈骨折患者30天死亡率的有效预测指标。在本研究中，我们旨在调查和评估NHFS在预测股骨远端骨折患者30天及一年死亡率方面的适用性。方法：对2012年6月至2017年10月期间入住一级主要创伤中心的股骨远端骨折患者进行回顾性研究。术前即刻使用相关参数记录NHFS。结果：纳入91例患者进行分析，平均随访32个月。平均年龄为69岁，56例（61%）为女性，10例（11%）为开放性骨折，32例（35%）为假体周围骨折，85%的患者接受了手术治疗。发现41例患者的NHFS>4。30天总死亡率为7.7%，1年总死亡率为21%。NHFS≤4的患者30天死亡率为6%，低于NHFS>4的患者，后者为9.8%（p=0.422）。根据Kaplan-Meier曲线绘制和对数秩检验，NHFS>4的患者1年死亡率为36.6%，高于NHFS≤4的患者，后者为8%（p=0.001）。结论：NHFS不仅是股骨颈骨折，也是股骨远端骨折患者术前优化风险分层的有前景工具以及死亡率的预测指标。
