Are Evaluation Scores Reliable Predictors of 30-Day and 1-Year Mortality in Fragility Neck of Femur Fractures?

Efthymios Iliopoulos^1*, Reichan Molla Moustafa¹, Ioannis Kougioumtzis¹, Konstantinos Tilkeridis¹, Athanasios Ververidis¹, Georgios Drosos¹

¹Metabolic Disease and Fragility Fractures Unit of Academic Department of Orthopaedics in General University Hospital of Alexandroupolis, Democritus University of Thrace, Greece

*Correspondence author: Efthymios Iliopoulos, MD, MBA(HSM), PhD, CCST(T&O), Assistant professor of Orthopaedics, Democritus University of Thrace, Greece; Email: [email protected]

Citation: Iliopoulos E, et al. Are Evaluation Scores Reliable Predictors of 30-Day and 1-Year Mortality in Fragility Neck of Femur Fractures? J Ortho Sci Res. 2025;6(1):1-6.

Copyright^© 2025 by Iliopoulos E, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Descriptives, pre-operative scores and mortality data of the cohort.

Table 2: Monovariant analysis of 30-day mortality.

Table 3: Monovariant analysis of one year mortality.

Table 4: Multivariant analysis results for 30-day and 1 year mortality (significant score is marked with *).

Discussion

The present study demonstrates the importance of the use of different evaluation scores as mortality prediction tools for patients sustaining a fragility neck of femur fracture. From the scores used the new mobility score had the most significant predictive capability for the one year survival. The NHFS, the AMTS and the age were other factors related with the mortality.

The Nottingham Hip Fracture Score (NHFS) was created for mortality prediction in fragility fracture of the hip in 2008. It includes an assessment of seven variables: age, sex, co-morbidities, hemoglobin concentration, cognitive status evaluation with AMTS, living arrangements and history of malignancy [8]. The 30-day prediction ability has been validated separately and in many countries [9-11]. However, the one year mortality rate was significantly related to the NHFS. Other studies, besides using of 30-day and one-year mortality rates, examine the score for early hospital discharge [12]. In contrast to our study, Nelson M, et al., 2020 demonstrated the good predictive ability of the score for 30 days , 6 months and one year mortality (p=0.001), but the number of patients included in their retrospective data collection was only 130 compared to the 380 of the present study [13]. Reports from some European countries suggest that the NHFS may underestimate mortality in specific cohorts of patients with fragility hip fractures. To address these variations, certain amendments have been proposed to better account for individual differences in these countries [14,15]. It is possible that the Greek cohort exhibits similar discrepancies, indicating that the NHFS could be adjusted to better suit local needs.

The Sernbo score was initially created to assist in deciding whether you choose total or hemi arthroplasty for femoral neck fractures [7]. Later it was found that this score also has one-year mortality prediction ability [16]. However, in our study, Sernbo did not show prediction ability for one-year mortality. It should be mentioned that we used it for all hip fractures, whereas it was specifically designed for femoral neck fractures and this may have influenced our results. In a study by Mellner, et al., 2021, the use of Sernbo score reliably predicted the one-year mortality in the Swedish national registry, which included all hip fractures in the elderly [16]. Further studies in other countries could clarify if this score has different predictive values in different cohorts.

The mobility status before the frailty fracture it is attended to be most reliable predictor of recovery after the fracture in the geriatric population [6,17,18]. Another study establishes that patients with walking ability without assistance before surgery live longer up to 1 year and ten years (p<0.001) [19]. The new mobility score was created for mortality prediction by assessing the mobility status in various conditions such as at home, outside and shopping abilities [20]. Α prospective study with 280 patients shows  the mobility status, which was evaluated with new mobility score, is a self-sufficient predictor for early postoperative outcomes during hospitalization . In the present study, the NMS had predictive ability for one-year mortality only in monovariant analysis. It is crucial to note that while all scores lose their significance in multivariate analysis only the NMS had predictive ability as a score. This result is consistent with the literature so far [6,20,21].

The mobility status before the frailty fracture it is attended to be most reliable predictor of recovery after the fracture in the geriatric population [6,17,18]. Another study establishes that patients with walking ability without assistance before surgery live longer up to 1 year and ten years (p<0.001) [19]. The new mobility score was created for mortality prediction by assessing the mobility status in various conditions such as at home, outside and shopping abilities [20]. Α prospective study with 280 patients shows  the mobility status, which was evaluated with new mobility score, is a self-sufficient predictor for early postoperative outcomes during hospitalization . In the present study, the NMS had predictive ability for one-year mortality only in monovariant analysis. It is crucial to note that while all scores lose their significance in multivariate analysis only the NMS had predictive ability as a score. This result is consistent with the literature so far [6,20,21].

Conclusion

Patients with fragility neck of femur fractures have high mortality risk. Different evaluation scores can be proven useful tools in the prediction of survival for these patients. The present study by using multivariant analysis, revealed that the new mobility score is the only independent predictive risk factors for 1 year mortality after a fragility hip fracture in the Greek population. Further studies should evaluate the predictive ability of mortality of other evaluation scores.

Conflict of Interests

As participants in this study, we collectively declare that none of us have any financial, personal or professional conflicts of interest that could inappropriately influence or appear to influence, the conduct, outcomes or reporting of this research.

Funding/Sponsorship

Not applicable

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