What is it about?

This article explains a type of broken leg called a distal femoral fracture – a break just above the knee – in older, often frail patients. It points out that these fractures are just as serious as hip fractures, with similar risks of complications and death, yet historically they’ve had less attention. Because of this, NHS England has now brought them under the same Best Practice Tariff (BPT) system as hip fractures, meaning hospitals are financially rewarded for meeting key standards (quick surgery, early geriatric review, early physio, bone health assessment, etc.). The article walks through: • What the bone looks like and how it breaks (often from a simple fall in someone with osteoporosis). • How patients present and are assessed in A&E, including checking circulation and nerves around the knee and using X-rays/CT scans. • Treatment options: o Non-surgical (plaster or traction), which usually means being stuck in bed for weeks and carries high risk of clots, chest infections, pressure sores and loss of independence. o Surgical options: plates, nails put inside the bone, or a knee-level replacement (distal femoral replacement) for very smashed or prosthetic-related fractures. It stresses the need for a multidisciplinary team, especially orthogeriatricians and physiotherapists, and the goal of getting patients up and fully weight-bearing as soon as possible. Finally, it highlights common complications, the importance of avoiding delay to surgery, and notes that more research is needed to compare the different operations. It concludes that current evidence supports intramedullary nails as a very good option in many elderly patients but stresses the importance of individualisation of treatment.

Featured Image

Why is it important?

This paper matters because it shines a spotlight on a group of patients who have been a bit “forgotten” by the system. We’ve known for years that hip fractures in older people are a big deal, with clear national standards, fast surgery and strong rehab pathways. But breaks just above the knee (distal femoral fractures) in the same frail patients are just as serious, yet they haven’t had the same organised approach. This paper pulls together the best available evidence and says, in simple terms: we need to treat these like hip fractures. It’s also one of the first papers to: Link these fractures directly to the hip-fracture-style Best Practice Tariff, explaining what this means for day-to-day care and hospital funding. Offer practical, clinic-ready guidance on assessment, choice of operation, and rehab, not just theory. Spell out a clear goal: early, safe full weight-bearing and getting patients back on their feet, rather than leaving them in bed. Highlight the need for a proper multidisciplinary pathway (orthopaedics, geriatrics, anaesthetics, physio, nurses) tailored to this fracture, not just borrowed piecemeal from hip fracture care. In short, it takes a neglected injury, explains why it deserves the same priority as hip fractures, and gives teams a structured way to improve outcomes.

Perspectives

This is one of the first papers to say, very clearly, “treat these fractures like hip fractures – and here’s how”, it also sets a template that others can follow. • Defines a standard of care for distal femoral fractures in frail older people, instead of leaving it to individual surgeon preference or local habit. Once something is written down and referenced, it’s much easier for hospitals and guideline-writers to say, “this is what we should all be doing.” • Links clinical care to funding and audit via the Best Practice Tariff. That moves distal femoral fractures from being a “niche” injury to something with measurable targets (time to surgery, early mobilisation, geriatric review), just like hip fractures. • Shows how to build a proper pathway – from emergency department to theatre to rehab and bone health – that other centres can copy, adapt and benchmark against. • Opens the door for other neglected fractures (e.g. peri-prosthetic or other fragility fractures) to argue for similar tariffs, standards and MDT pathways using the same logic. So it doesn’t just help current patients – it helps reshape how future services, audits and national policies are designed.

Christian Chess
Royal United Hospital, Bath

Read the Original

This page is a summary of: Management of Distal Femoral Fractures in the Elderly, British Journal of Hospital Medicine, October 2025, Mark Allen Group,
DOI: 10.12968/hmed.2024.0693.
You can read the full text:

Read

Contributors

The following have contributed to this page