Management of Fragility Femoral Fractures: A UK Regional Multicentre Audit of the British Orthopaedic Association Standards for Trauma (BOAST) Guidelines

Background Fragility fractures of the femur, excluding the neck of the femur (NOF), are increasingly common and associated with significant morbidity in the older population. Current best practice in the UK recommends that surgery should permit full weight bearing (FWB) and be performed within 36 hours of admission. Methods A multicentre retrospective audit was conducted across patients admitted to seven NHS hospitals in the UK in 2021. Patients aged ≥65 years with low-energy, non-NOF femoral fragility fractures who underwent surgery were included. Data were collected on fracture classification, operative treatment, weight-bearing prescription and achievement, time to surgery, length of stay, and discharge destination. Results A total of 358 patients met the inclusion criteria: hip periprosthetic fractures (n = 171, 48%), distal femur fractures (n = 67, 19%), midshaft fractures (n = 65, 18%), and knee periprosthetic fractures (n = 55, 15%). Fixation was the predominant treatment (n = 303, 85%), with plating being the most common. Joint arthroplasty (n = 54, 15%) was associated with more permissive postoperative prescriptions than fixation (n = 41 (76%) vs. n = 173 (57%)). Of 342 patients with time-to-surgery data, only 86 (25%) received surgery within 36 hours. Arthroplasty procedures more frequently breached this timeframe (n = 46, 85%) when compared to fixation (n = 218, 72%). Median length of stay was shorter when surgery occurred within 36 hours (13 days vs. 17 days). Weight-bearing prescription was not associated with length of stay, but was associated with discharge destination. FWB patients were more frequently discharged home. Conclusion In the UK, fixation remains the most common treatment for non-NOF fragility femoral fractures, despite being associated with less permissive weight-bearing prescriptions and less independent discharge outcomes than arthroplasty. Delay beyond 36 hours was common, particularly in arthroplasty cases, and was associated with prolonged hospital stay. Improved access to revision arthroplasty surgeons is required to achieve compliance with the British Orthopaedic Association Standards for Trauma (BOAST) guidance.