Expansion of the NHFD – Femoral Shaft Fractures and Periprosthetic Fractures 

Description

In this presentation, Dominic Inman discusses the evolution and expansion of the Best Practice Tariff (BPT) in England, originally aimed at enhancing care for hip fracture patients. He outlines how the BPT incentivized financial support for treating hip fractures for over ten years, leading to improved outcomes for these patients. However, the existing system left many elderly patients with lower femur fractures without similar incentives, despite evidence of comparable mortality rates.



In 2020, a decision was made to include all patients aged 60 and over with femoral fractures under the BPT, expanding the focus to also include those with periprosthetic fractures. Although the BPT was intended to evolve, the COVID-19 pandemic delayed these changes, resulting in temporary block payment systems for hospitals.



The persisting need for equitable care is emphasized as studies show substantial evidence that non-hip fractures require similar urgency in treatment and service provision as hip fractures. Despite the challenges posed by the pandemic, the presentation highlights the importance of continued data collection on all types of fragility fractures to better understand and improve patient outcomes. In the final segments, Inman addresses the role of nerve blocks in pain management for these patients and the benefits of early surgical intervention, along with the need for ongoing analysis of treatment practices and outcomes across broader fracture categories.

DOI: 10.1302/3114-221643

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