GIRFT clinical lead for adult orthopaedic trauma surgery Bob Handley and GIRFT orthogeriatric advisor Judith Agwada-Akeru have welcomed the 2025 National Hip Fracture Database (NHFD) Annual Report, published on 11 September, along with a summary of findings.  

Each year over 70,000 people in England, Wales and Northern Ireland have a hip fracture. The NHFD collects data relating to the care of these patients and provides analysis and interpretation for clinical staff, patients and their families about hip fracture care and clinical outcomes.  

Hip fracture patients are a well-monitored group but are part of a much broader group of patients who may have other fragility fracture injuries which affect mobility; these are termed non-ambulatory fragility fractures or NAFFs.  Data on hip fracture care may have been taken as representative of other NAFFs, but this is a presumption, and it is widely thought that the pathway of care for other injuries may differ and may well be worse.   

Recognising this, Bob and Judith welcome a new step for NHFD where, for a trial period from January 2026, data on pelvic ring fractures is to be collected in addition to hip fractures.  

They comment:

“The huge numbers of people sustaining NAFF injuries make the findings of NHFD report relevant not just to those directly involved but to us all, as there are consequences for the whole NHS and social care. 

The pilot for pelvic ring fractures is a step towards fulfilling the concept that patients with similar needs should be treated similarly, irrespective of the precise anatomical location of their fracture. The inclusion of pelvic ring fractures will give a better understanding of the inequities in the care of non-neck of femur non-ambulatory fragility fractures and implementation of the GIRFT Non Ambulatory Fragility Fracture Pathway.” 

In May 2024, Bob led a working group which developed a GIRFT national pathway to be applied to all NAFF patients regardless of their injury site. The NHFD report acknowledges this work and hopes that the results of the 2026 audit of pelvic ring fracture will lead to improved equity in the management and care of patients with fragility fractures other than neck of femur hip fractures.   

There have been some recurrent themes in NHFD reports and these are highlighted again in the latest annual report with key recommendations summarised as:  

• Getting patients to be in the right place and in the care of the right team within four hours. Compliance is currently poor and the NHFD report suggests an initial objective of achieving this for at least 20% of patients.  

• Consistency in implementing the objective of care to allow early weightbearing and mobilisation, both in the surgical plans and availability of staff to implement those plans. 

• Better compliance with protection against further fractures by wider adoption of injectable bone protection with the intention that for hip fracture patients at least half are on bone strengthening medication four months after surgery. 
   

They said:

“We recommend reading the 2025 NHFD report which presents information on the care of the huge number of patients with injuries affecting their independence and quality of life. It highlights both the achievements and shortcomings of services and makes considered recommendations for the future.”  

Webinar to discuss the NHFD annual report findings  

The National Hip Fracture Database (NHFD) is hosting a webinar on Thursday 6 November at 5.30 – 7pm to discuss the NHFD annual report findings. Click here to reserve your place.