Abstract
The histological findings from the heads of femur or bone biopsy taken from 90 patients with suspected pathological fractures of the femoral neck were studied to determine the rates of significant abnormal pathological findings.The mean age at the time of fracture was 80.41 years (44–99). 29 patients were males and 71 females. The patients were divided into four groups. Group I: 34 patients with fracture without history of fall or trauma. Group II: 21 patients with suspicious radiology of pelvis. Group III: 27 patients with past history of malignancy without known bone metastases. Group IV: 8 patients with past history of malignancy and known bone metastases
None of the patients in groups I and II had significant abnormalities other than osteoporosis. 4 patients (15%) in group III had metastases and 6 patients (75%) in group IV had metastases on histological examination.
We conclude that the absence of history of fall or trauma or subtle radiographic findings in patients with fracture of the neck of the femur is usually not associated with sinister pathology and the cause of fracture in these patients is often osteoporosis. Patients with previous history of malignancy without known bone metastases have a 15% risk of finding of metastatic disease even in the absence of radiological abnormalities. Patients with fractured neck of femur with past history of malignancy and who are known to have bone metastases must be considered as having pathological fractures through metastatic disease until unless proven otherwise
The abstracts were prepared by Mr Roger Tillman. Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
