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It is recommended that full-length femoral radiographs should be obtained in patients presenting with a femoral neck fracture and a co-existent history of malignancy. Over a two-year period, we identified 133 (47 males, 86 females) patients admitted with a femoral neck fracture and a co-existent history of malignant disease, representing 6.5% of all femoral neck fractures admitted within this time frame. None of the patients had previously diagnosed bone metastases. The mean patient age was 80 years (range, 30-97 years). In 114 cases the fracture was traumatic in origin, most commonly a simple fall (86%). In 19 cases the fracture was atraumatic with histopathological analysis demonstrating the presence of bony metastases. Overall, breast (35%), lower gastrointestinal (22%), prostatic (18%) and bronchogenic carcinomas (7%) were the most common associated malignancies. On reviewing the full-length anteroposterior and lateral femoral radiographs, none of the patients had demonstrable pathology in the remainder of the femur. Furthermore, none of the patients to date have required readmission with a secondary fracture relating to disease in the middle or distal thirds of their femur. We conclude that full-length views of the femur are of limited value in patients presenting with a femoral neck fracture and a co-existent history of malignant disease.

Objective To study the outcome following treatment for proximal femoral fracture in elderly people. Methods All consecutive males and females admitted to the acute fracture service at the Royal Victoria Hospital and the Belfast City Hospital for the 3 years from 1999 to 2001 were studied. The data was collected by trained research nurses. Variables gathered included age, sex, marital status, mental state, pre-injury Barthel score and the American Society of Anaesthesiology (ASA) physical status grading. The information was gathered on admission to hospital and at four, six and 12 months after the injury. Results The total number of patients studied between January 1999 to December 2001 was 2834 of whom 77% were female and 23% were male. The mean (median) length of stay in the acute fracture service was 10.7 (9 days). The mean (median) length of stay in the rehabilitation ward was 35.3 (24 days). The 30-day mortality was 6.9%, the four-month mortality 15.6 % and one year mortality 22.3 %. Of those subjects living at home at the time of fracture 68% remained at home at one year. Factors predicting successful return home were higher mental test score, younger age, female sex, higher Barthel score, better pre-injury mobility and better ASA score. Of those able to walk independently outdoors before injury 40% regained this ability by 12 months. Factors predicting return of pre-injury mobility were poorer pre-injury mobility, younger age, higher mental test score, better ASA category, higher Barthel score, and previous residence at home. The proportion admitted from their own home and discharged by 56 days was 56%. Conclusion The standardised measurement of outcome in hip fracture subjects enables comparison between units and facilitates improvement in standards of care available to the increasing number of elderly patients presenting with proximal femoral fracture.