Patients with proximal femoral fracture are frail with multiple comorbidities and the anaesthesia often proves a greater challenge than the surgery itself. The aim was firstly, to determine whether general, compared to regional anaesthesia, caused a decrease in the mental test score (MTS) of patients with proximal femoral fracture. Secondly, what effect does a reduced MTS have on the general outcome for such patients?

A prospective observational study was conducted in a regional trauma centre. 170 consecutive patients over 60 years of age (mean age 82.6 years) were included. Age under 60 years was the only exclusion criterion. Pre- and postoperative (day 5) MTS values were recorded by the same clinician.

The MTS decreased by 2.43 points when general anaesthesia was administered compared to 1.5 for regional anaesthesia (p< 0.01 Mann Whitney). Lower postoperative MTS values were associated with increased mortality (p< 0.001 Mann Whitney). The greater the decrease in MTS (between pre- and postoperative values) the more likely it is that the patient will be institutionalised (p< 0.01 Mann Whitney).

Reduced mental function as observed after general anaesthesia is associated with increased mortality and institutionalisation. Thus the increased use of regional anaesthesia is advocated.

Proximal femoral fracture (PFF) is already epidemic and projected to increase. 50% of patients fail to recover their preaccident mobility, resulting in protracted hospitalisation and exposure to nosocomial (hospital acquired) infections which impairs recovery further.

The aim of this study was to establish the rate at which patients with PFF regain mobility, the point at which they cease to recover and the incidence, time of onset and effect of nosocomial infections.

Recovery of mobility and nosocomial infection was prospectively recorded in 170 consecutive patients with PFF. 53% regained their best level of mobility within 6 days of admission, 81% within 8 and 91% within 14. The mean hospital stay was 21 days and delay to discharge was 14 days. During the delay, mobility deteriorated in 22% of patients and 58% developed nosocomial infection of which 18 were methicillin resistant staphylococcus aureus. The risk of infection doubled after a delay of 6 days.

Protracted hospitalisation after PFF is unhelpful and dangerous to patients and wasteful of healthcare resource. There is a small window of opportunity to discharge patients after PFF that is often missed. Thus there are often no beds for patients with acute fractures because they are occupied by patients who do not benefit from hospital admission or remain because they have acquired iatrogenic disease.

General Practitioner (GP) attendances for non-specific disease increase after life events. Whiplash injury has the effect of a life event in some people.

The aim of this study was to compare GP attendance rates in the year before and after whiplash injury to establish their rate and cause.

Ninety-eight subjects (62 women and 36 men) with whiplash injuries examined for medicolegal reports, with complete GP records for a year before and after injury.

The number of attendances and the reason for attendance. Consultations after the accident were subdivided into those for neck pain and for other reasons.

Subjects were reviewed more than one year after injury. All described neck pain 11% mild, 62% moderate and 27% severe. GP attendance rates before the accident were within the normal range but increased after (p=0.0001) because of neck pain symptoms. There was no association between attendance rates before and after injury but consultations for neck pain rose in proportion to severity of symptoms (p = 0.0015). Attendances unrelated to neck symptoms fell after injury (p = 0.002).

GP attendances for non-specific disorders increase after life events, but not after whiplash injury as patients focus on their neck symptoms.