Weight-bearing Status Following Non-Neck of Femur Fragility Femoral Fractures: A Regional Audit of Practice in Wessex Deanery

A Denning, R Ormiston, A Assaf, K Pearce, T Moore, Z Lyon, D Hancock, S Saleem, S White

Salisbury NHS Foundation Trust

The aging population has increased the incidence of femoral fractures. The BOAST – Care of the Older or Frail Orthopaedic Trauma Patient Guidelines state these patients should be operated on with intention to fully weight-bear (FWB) within 36 hours. Although commonplace in NOFs, this standard is often not applied to non-NOF fractures.

This was a regional retrospective audit including all Wessex hospitals performing trauma surgery. We assessed compliance with BOAST guidance. Patients admitted in 2021 that underwent surgery for fragility non-NOF femoral fractures were included. Our primary outcome was prescribed weight-bearing status. Secondary outcomes included time to theatre, LOS, and discharge destination.

370 patients were included. This included 59 shaft fractures, 78 distal femoral fractures and 233 peri-prosthetic fractures (168 THR, 55 TKR, 10 other). 55% of patients were FWB post-operatively. Average LOS was 19 days – LOS was 16 days if FWB and 22 days if restricted weightbearing (RWB). Average time to theatre was 4 days. The major trauma centre (MTC) had higher proportion of patients FWB post-operatively. Highest amount of RWB was seen in THR periprosthetic fractures treated with ORIF.

Despite BOAST guidelines advising early intervention with intention to FWB patients, only 55% of patients were prescribed to do so and time to theatre was 4 days. There is a large discrepancy between weightbearing status amongst hospitals in the region. We need to consider why we neglect national guidance by imposing weightbearing restrictions on our non-NOF femoral fractures when NOFs routinely mobilise unrestricted.