Bone & Joint Open · Feb 6, 2026

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

By Vaghela M, Arbis A, Benson D et al.

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.

doi.org/10.1302/2633-1462.72.bjo-2025-0252.r1Open accessPubMed 41643738Biomarkers