Adherence to the British Orthopaedic Association Standards for Trauma (BOAST) Guidelines for the Management of Neck of Femur Fractures

IntroductionOver 72,000 hip fractures occur annually in the United Kingdom, costing over £2 billion, with 10% mortality at 30 days and 30% annually.Therefore, the study aimed to compare hip fracture care at North Manchester General Hospital with the British Orthopaedic Association Standards for Trauma (BOAST) guidelines. MethodologyA retrospective review of electronic patient records at Manchester University NHS Foundation Trust was conducted from September to November 2025.Patients aged >60 years with native intracapsular or extracapsular femoral neck fractures, or those aged >60 years with pathological femoral neck fractures, were included.Descriptive analysis was performed to ascertain compliance with BOAST guidelines. ResultsThe management of 51 patients was audited against 13 BOAST parameters.100% compliance was achieved in seven parameters: certainty of diagnosis, a multidisciplinary team (MDT) approach to patient care, preoperative optimisation by an orthogeriatric team within 72 hours, documented weight-bearing status, falls risk assessment, bone health assessment, and data entry into the National Hip Fracture Database (NHFD).Parameters with less than 100% compliance were post-operative physiotherapy (50, 98%), venous thromboembolism (VTE) prophylaxis (50, 98%), analgesia (46, 91%), VTE assessment (45, 88%), postoperative delirium assessment (43, 84%), and surgery within 36 hours (32, 62.8%).Reasons for noncompliance included transfer to the intensive care unit (ICU) for post-operative physiotherapy; workloadrelated delays in VTE prophylaxis; unfamiliarity with local analgesia protocols among newly appointed National Health Service (NHS) doctors; inconsistent documentation of VTE assessment; and inconsistent completion of post-operative delirium assessments, with unclear responsibilities between doctors and coordinators.Limited theatre capacity and the need for medical optimisation accounted for non-compliance with the 36-hour surgery target. ConclusionsBOAST compliance was good overall, but gaps in documentation, timing, and role clarity remain.Improvements include enforcing admission checklists, recording arousal, attention, and acute change using the abbreviated mental test-4 (4AT), pharmacist incident reporting, trauma coordinator oversight, and neck of femur training.