The Nottingham Hip Fracture Score (NHFS) was developed in 2007 as a predictor of 30-day mortality after hip fracture surgery following a neck of femur fracture. The National Hip Fracture Database is the standard used which calculated their own score using national data. The NHF score for 30-day mortality was calculated for 50 patients presenting with a fractured neck femur injury between January 2020 to March 2020. A score <5 was classified as low risk and >/=5 as high risk. Aim was to assess the accuracy in calculating the Nottingham Hip Fracture Score against the National Hip Fracture Database. To explore whether it should it be routinely included during initial assessment to aid clinical management?. There was an increase in the number of mortalities observed in patients who belonged to the high-risk group (>=5) compared to the low risk group. COVID-19 positive patients had worse outcomes with average 30-day mortality of 6.78 compared to the average of 6.06. GEH NHF score per month showed significant accuracy against the NHFD scores. The identification of high-risk groups from their NHF score can allow for targeted optimisations and elucidation of risk factors easily gathered at the point of hospitalisation. The NHFS is a valuable tool and useful predictor to stratify the risk of 30-day mortality and 1-year mortality after hip fracture surgery. Inclusion of the score should be considered as mandatory Trust policy for neck of femur fracture patients to aid clinical management and improve patient safety overall

Introduction. Most western countries have implemented fast-track hip fracture aiming at surgery within 24 hours, since the mortality rate hereafter rises markedly. In Greenland, it is not achievable to operate within 24 hours. Arctic people live in sparsely populated areas and Greenland's population is scattered along the vast coastline. All patients must be chartered to Nuuk by airplane which can take up till several days to weeks, due to logistics and the Arctic weather. This presents a challenge regarding adhering to western guidelines. The operative delay may be acceptable though, as it is the impression that the Greenlandic population survives and endures better than patients of western populations. However, as data are lacking, we aimed to describe mortality among hip fracture patients in Greenland taking frailty and comorbidities into account. Method. All patients with ICD-10 codes DS720, DS721 and DS722 from 2018-2022 were identified as 261 patients diagnosed with hip fractures. Variables including time of diagnosis, time to operation, reasons for delay, ASA-score, Charlson Comorbidity index, time of death, and other possible confounding variables were analyzed. Primary outcome was mortality rates at 30-day post-OP and 1-year post-OP. Results. The average time from fracture to operation was 91.4 hours. In the Danish Cohort (DC) 70,6 % of patient were operated within 24 hours. Overall, 30-day mortality was 9,9 %, and 1-year mortality was 29,4 %, compared to the DC with 10,8 % 30-day mortality and 28,3 % 1-year mortality. Multivariate regression was conducted, showing no statiscal significant increase in mortality, despite extended delay. Conclusion. With no increase in death, the authors find it justifiable that patients in Greenland endure longer delays than the western population. The influence on further adverse effects needs to be investigated as well as causes of survival, but perhaps the Arctic people unveil mechanisms for raised survival among other populations

Object. The aim of this study was to investigate the impact of the COVID-19 pandemic on the management and outcome of patients with neck of femur fractures. Methods. Data was collected for 96 patients with neck of femur fractures who presented to the emergency department between March 1, 2020 and May 15, 2020. This data set included information about their COVID-19 status. Parameters including inpatient complications, hospital quality measures, mortality rates, and training opportunities were compared between the COVID-19 positive and COVID-19 negative groups. Furthermore, our current cohort of patients were compared against a historical control group of 95 patients who presented with neck of femur fractures before the COVID-19 pandemic. Results. Seven (7.3%) patients were confirmed COVID positive by RT-PCR testing. The COVID positive cohort, when compared to the COVID negative cohort, had higher rates of postoperative complications (71.4% vs 25.9%), increased length of stay (30.3 days vs 12 days) and quicker time to surgery (0.7 days vs 1.3 days). The 2020 cohort compared to the 2019 cohort, had an increased 30-day mortality rate (13.5% vs 4.2%), increased number of delayed cases (25% vs 11.8%) as well as reduced training opportunities for Orthopaedic trainees to perform the surgery (51.6% vs 22.8%). Conclusions. COVID-19 has had a profound impact on the care and outcome of neck of femur fracture patients during the pandemic with an increase in 30-day mortality rate. There were profound adverse effects on patient management pathways and outcomes while also affecting training opportunities

Hip fractures are a common injury in elderly patients. The UK has a National Hip Fracture Database to collect data on all patients presenting to hospital with a hip fracture. Literature evidence suggests that early surgery for hip fracture patients improves morbidity and mortality. UK national guidelines (BOA, NICE) recommend that surgery is performed within 36 hours of presentation and/or diagnosis for inpatients. Best Practice Tariffs ensure that hospitals are paid a set value if they meet this target of surgery within 36 hours. This study aims to look at reasons for delay to surgery for patients presenting to our busy level 2 trauma unit. This is a retrospective review of prospectively collected data for patients referred to the orthopaedic team at our hospital with a diagnosis of a neck of femur fracture between 1st April and 31st December 2018. Patients under the age of 65 year of age were excluded from our study. Only patients who were operated on after 36 hours were included. The database for reasons of surgical delay was reviewed and electronic patient records were used to collect further data on length of stay and 30-day mortality. A total of 249 patients were diagnosed with a hip fracture during the study period. 2 patients were too unwell for an operation and died within 24 hours of diagnosis/admission. 46 patients were included in the study. The primary reasons for surgical delay were patients not being fit for surgery (14/46) and the use of anti-coagulation (14/46). Other reasons included a lack of surgical capacity (7/46) and delayed diagnosis due to further imaging (CT). Mean delay to surgery was 51.8 hours (range 34.5 – 157.2 hours; median 42.9 hours), mean length of stay 20.4 days (range 5.3 – 55.7 days, median 15.6 days). 30-day mortality was 4/46 (8.6%) for patients who were delayed. Many of the issues we found in this study are unusual however these problems are commonly faced in many level 2 trauma units that serve an ever growing ageing population. Changing practice to provide improved out-of-hours medical care to facilitate medical optimisation and using current literature evidence that shows that the use of DOACs/NOACs does not adversely affect outcomes when patients are operated on within 24 hours of the last dose may help improve times to surgery

Introduction. We aimed to study the rates of both surgical and medical complications associated with femoral diaphysis fracture fixation with intramedullary nailing including all fracture mechanisms. Additionally, we investigated whether the trauma energy has an impact on the complication risk. Method. In this retrospective cohort study, the health records of 491 patients with 503 femoral fractures, who underwent surgery between May 2007 and May 2022 in Tampere University Hospital, were reviewed. Patients who underwent a primary operation with a reamed rigid intramedullary nail for a diaphyseal femoral fracture and whose follow-ups were organized at the same hospital district, were included. Based on those criteria, 57.5% were included for analysis (279 patients with 289 fractures). The complications were then recorded by chart review. To investigate the impact of trauma energy on complication risk, we compared complication proportions in high- and low-energy groups and calculated odds ratios. Result. The crude percentage of 30-day mortality was 2.1% (6 of 289) based on information obtained from the patients’ records. The overall proportion of complications was 22.5%. The risk of any medical complication was 2.8%, whereas the risk of surgical complication was 19.8%. The risk of complications was nearly twice as high in high-energy fractures compared to low-energy fractures, with an odds ratio (OR) of 1.92, 95% CI 1.03-3.75. The risk of reoperations was significantly increased in high-energy traumas (OR 2.46, CI 1.25-5.24). Conclusion. This study reveals a 2.1% risk of thirdy-day mortality and a 22.5% risk of overall complications, predominantly of a surgical type. The complication risk, especially the risk of surgical complications, is higher among the patients with fractures caused by high-energy injury compared to low-energy fractures, highlighting the importance of timely identification of those complications for providing better postoperative care

Recent National Institute for Health and Care Excellence (NICE) guidance has advised against the continued use of the Thompson implant when performing hip hemiarthroplasty and recommended surgeons consider using the anterolateral surgical approach over a posterior approach. Our objective was to review outcomes from a consecutive series of Thompson hip hemiarthroplasty procedures performed in our unit and to identify any factors predicting the risk of complications. 807 Thompson hip hemiarthroplasty cases performed between April 2008 and November 2013 were reviewed. 721 (89.3%) were cemented and 86 (10.7%) uncemented. 575 (71.3%) were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%). Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (7 of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% CI 2.8 to 26.3) p < 0.001). Surgeon grade and patient history of cognitive impairment did not have a significant impact on dislocation rate. Patients were discharged home in 459 cases (56.9%), to a care home or other hospital in 273 cases (33.8%). 51.8% (338 of 653) returned home within 30 days. 75 died during their admission (9.3%). 30-day mortality was 7.1% and 1-year mortality was 16.6%. Intraoperative fracture occurred in 15 cases (1.9%) of which 14 were cemented. Superficial or deep infection occurred in 33 cases (4.1%). We recommend against the continued use of the posterior approach in hip hemiarthroplasty, as enhanced soft tissue repair did not reduce dislocation rates to an acceptable level. Our findings, however, demonstrate satisfactory results for patients treated with the Thompson hip hemiarthroplasty performed through an anterolateral approach. We suggest that the continued use of the Thompson implant in a carefully selected patient cohort is justifiable

This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic, and long bone fractures; interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews; and pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews