The use of Nottingham Hip Fracture score as a predictor of 1-year mortality risk for periprosthetic hip fractures.

AIMS

The primary aim was to determine if the Nottingham Hip Fracture Score (NHFS) could be used to stratify 1-year mortality risk amongst periprosthetic hip fracture patients. The secondary aim was to identify 1year mortality rates amongst surgically managed periprosthetic hip fractures.

METHODS

Our electronic fracture database was interrogated for all Vancouver B or C periprosthetic fractures between September 2009 to April 2019; 83 patients were identified. All available data was then collected from radiographic, electronic and paper notes. The NHFS was retrospectively calculated for each patient. Statistical analysis was performed to identify factors significantly affecting 12month mortality using Akaike's information criterion corrected for small sample sizes (AICc), binomial logistic regression was performed using each variable; the p-values presented are for the coefficients of the regressor.

RESULTS

Periprosthetic fractures have a 1year mortality risk of 26.5%, 30 day mortality was 4.82%. The NHFS was found to be highly predictive of 1-year mortality amongst this patient cohort (p = 0.0001). We find that each unit increase in the NHFS is correlated with a 2.7times increase in mortality rate. There was no evidence that time lag from presentation to surgery led to an increased mortality (p = 0.455).

CONCLUSION

The NHFS can be used to stratify the 1-year mortality risk amongst patients who have periprosthetic hip fracture; this is a new finding not previously published to our knowledge. Given that time to surgery does not correlate with mortality, patients should be risk stratified on admission with NHFS. Time is then available to conduct a multi-disciplinary approach to optimize the patient, personnel and equipment. The introduction of a parallel multidisciplinary pathway to neck of femur fractures is long overdue and must be expedited.