Abstract
Introduction: Fractures of the femoral neck are common in elderly patients. Malignancy increases in incidence with increasing age. Therefore, it is inevitable that a proportion of patients with a history of malignancy will suffer a fracture of the femoral neck.
Our aim was to quantify the proportion of patients admitted with a femoral neck fracture and a co-existent history of malignancy, and determine if full-length femoral radiographs are beneficial in preoperative screening of distal metastatic disease.
Methods: 133 patients (47 males, 86 females) were admitted with a femoral neck fracture and co-existent history of malignant disease from January 2004 to 2006. The mean age was 80.1 years (range, 30–96 years). In 114 cases the fracture was traumatic in origin. In 19 cases the fracture was pathological, presenting most commonly with increasing pain.
Primary malignancies included breast (34.6%), large bowel(21.8%), prostatic (18.0%) and bronchogenic carcinomas (6.8%).
There were 73 extracapsular fractures and 60 intracapsular fractures. For the intracapsular fractures 49 cases were treated with hemiarthroplasty, 4 cases by total hip arthroplasty and 7 cases using cannulated screws. For the extracapsular fractures, 59 cases were stabilized using a DHS and 14 cases were managed by intramedullary nailing.
Results: A consultant radiologist reviewed all 133 full-length femoral radiographs (AP and lateral). No patients had evidence of distal pathology visible. No patients were re-admitted with a secondary fracture relating to the development of disease in the distal femur.
Conclusion: Femoral neck fractures do occur in patients with a co-existent history of malignancy. Full-length femoral radiographs of the femur are of no additional benefit for preoperative planning. These patients can be managed similarly to other patients presenting with a femoral neck fracture..
Correspondence should be addressed to Mr John Hodgkinson, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
