Weight-bearing status following non neck of femur (NOF) fragility femoral fracture
Authors:
Alex Denning, Rory Ormiston, Saharish Saleem, Jonathan Quayle
Hospital:
Salisbury District Hospital NHS Foundation Trust
Introduction:
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.
Methods:
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.
Results:
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%).
Conclusions:
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.