Background: The exact incidence of cancer (primary/metastatic) leading to pathological fracture in femoral neck is not clear. Bone specimen is often sent for histology in suspicious cases. This retrospective study was aimed to answer the above question and to review our hospital practice in managing these patients.

Materials & Methods: All patients with fracture neck of femur undergoing surgery and had bone specimen taken for histo-pathological examination between 01.01.2002 and 31.12.2003 were included. Case notes and histology reports were reviewed.

Results: Out of total 533 patients with femoral neck fracture, 32 (6%) patients had bone specimen taken for histology. 9 male & 23 female patients with mean age of 82 years. 58% had past history of cancer (commonest being breast) with/without suspicious lesion on x-rays where as the remaining had no history of cancer but suspicious lesion on x-rays. 4 (12.5%) had positive histology results. All four had metastatic disease (2 from breast, 1 from renal and 1from multiple myeloma). Only 19% had results documented in case notes but 81% had reports filed in notes. Appropriate referral was made to oncology team for three patients. The fourth patient with multiple myeloma died in hospital before the referral. Four of 28 (14%) patients with negative results died within 3 years following the surgery compared to only 1 (multiple myeloma) out of 4 patients with positive results.

Conclusion: The incidence of suspicious pathological femoral neck fracture was 6% but incidence of cancer was 0.7%. All positive cases were metastatic. Commonest primary was from breast – adenocarcinoma). Mortality in negative cases was 16% at average of 3 years compared to 25% in metastatic fracture patients.