Weight-bearing status following non neck of femur (NOF) fragility femoral fracture

Alex Denning, Rory Ormiston, Saharish Saleem, Jonathan Quayle

Salisbury District Hospital 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 full weight-bearing (FWB) within 36 hours. This standard is often not applied to non-NOF fractures.

This single-centre retrospective audit assessed compliance with this guidance. Patients admitted in 2021 that underwent surgery for fragility peri-prosthetic or non-NOF femoral fractures were included. Our primary outcome was prescribed weight-bearing status. Reasons for restricted weight bearing (RWB) were then analysed. Secondary outcomes included time to theatre, LOS and discharge destination.

25 patients met the inclusion criteria. This included 4 mid shaft fractures, 6 distal femoral fractures and 15 peri-prosthetic fractures (8 THR, 7 TKR). 40% of patients were FWB post-operatively. Retrospective analysis suggested that within the RWB group, fixation was sufficient to allow FWB in 10 patients, 2 patients would have required alternative fixation to allow FWB, 3 patients had appropriately restricted weight-bearing. Neither group required revision fixation. Average LOS was 22.4 days – LOS was 16 days if FWB and 24 days if RWB. Patients were discharged to their pre-hospital residence at similar rates in each group (50% v 52%).

Despite guidelines advising early intervention with intention to FWB patients, only 40% of patients were prescribed to do so. Patients allowed to FWB post operatively had a shorter LOS. Fixation was appropriate to allow FWB in the majority of cases.