Osteologie/Osteology · Feb 23, 2026
Predictive value of the Clinical Frailty Scale for outcomes in patients with proximal femoral fractures – an analysis from the geriatric trauma registry
By Knauf T, Bücking B, Ketter V et al.
INTRODUCTION: Frailty is a widespread clinical syndrome characterized by impaired physiological reserves, impaired cognition, and an increased predisposition to adverse health outcomes. The Clinical Frailty Scale (CFS) is now an established screening tool for predicting frailty, including in patients with hip fractures. In this context, the predictive value of the CFS for mortality, length of stay, and return to the home environment has been demonstrated. In this analysis from the geriatric trauma registry, we aim to additionally investigate its predictive value for further outcome parameters, such as mobilization, EQ5D, and surgical and nonsurgical complications. METHODS: Overall, data on the CFS were available for 29.347 patients from 170 geriatric trauma centers. This analysis is limited to the years 2022-2024. Patients≥70 years who underwent surgery for a proximal or periprosthetic/peri-implant femoral fracture are included in the AltersTraumaRegister. In addition to baseline characteristics, we evaluated treatment-related data on the course of treatment and outcomes. RESULTS: 57% (n=16.584) of patients had a CFS≥ 5 and were therefore considered frail. Compared with patients who were not assessed as frail, patients assessed as frail had a higher ASA score, poorer walking ability (able to walk independently: 17% vs 59%), more frequent nursing home placement (30% vs. 5%), and a higher rate of delirium on admission (32% vs. 10%). Outcomes during the inpatient stay also showed reduced walking ability (70% vs. 89%), a higher rate of nonsurgical complications (47% vs. 35%), a comparable rate of revision surgery (3%), more frequent discharge to a nursing home (39% vs. 14%), a lower EQ5D (0.42 vs. 0.69), a shorter length of stay (15 vs. 16 days), and increased mortality (8% vs 3%) in patients with a positive CFS. A similar pattern is also seen at the 120-day follow-up. DISCUSSION: At 57%, more than half of patients with hip fractures are assessed as frail. The CFS is suitable for easily identifying patients who are frail. We were able to demonstrate that patients with a CFS≥5 have an increased risk of nonsurgical complications, poorer mobility after 7 days, and a lower EQ5D. In addition, we were able to confirm the predictive value for discharge destination and mortality already described in the literature. These differences also persist at the 120-day follow-up. Mortality in particular shows a markedly increased risk, at 15% vs. 5%. In addition, patients with a CFS≥5 have nearly twice the risk of a contralateral femoral fracture (1.2% vs. 0.7%). CORRESPONDENCE ADDRESS: Tom Knauf, Helios Kliniken Kassel, Trauma Surgery, Hansteinstraße 29, 34121 Kassel, Germany, E-mail: tom.knauf@helios-gesundheit.de Publication History Article published online: 23 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany