Introduction: The first BOA “Standards for Trauma” detail clear management standards for hip fracture patients aged over sixty including the goal that surgery should be within 48 hours of admission. With an expanding elderly population and the number of people suffering a hip fracture increasing by 2% a year there will be an increasing burden on trauma services.

We have demonstrated that simple targeted changes can make a significant difference to wait till surgery after hip fracture.

Methods: Comprehensive data was gathered prospectively on all hip fracture admission over two 3 month periods one year apart. On the basis of the poor results in the first 3 months and after discussions with the general surgeons and anaesthetists, the following changes were implemented:

2pm to 5pm weekday trauma lists were extended from 2pm to 7pm two days a week.

Priority for one hip fracture case first thing on the CEPOD emergency list each day.

Fortnightly morning ‘day case’ trauma list for minor cases.

Results: Approximately 100 hip fracture admissions in both 3 month periods. Initially 72% of patients waited more than 48 hours, 75% of these were due to logistical reasons (mainly lack of space on trauma lists). The percentage of patients operated on within 48 hours improved from 28% to 95%.

Discussion: Auditing local practice against BOAST guidelines identified that logistical reasons (mainly lack of capacity) were the major cause for delay in our trust. Presenting and discussing these results with general surgical and anaesthetic colleagues enabled simple changes that allowed us to meet the new BOA targets.

Conclusion: We suggest that trusts audit their compliance with the new BOA standards for trauma. We have shown how this can be used to design simple improvements in service to significantly reduce waiting times for patients. Let us not write off conservative treatment of tibial shaft fractures

1. Sections were cut from the third metacarpal, the radius, the femur and the third lumbar vertebra of thirty-four male and twenty-one female cadavera. The mineral content of these different specimens was measured by ashing and the relationships between the quantity of bone mineral present at these sites were examined.

2. In the females the whole bone density and mineral/unit length at both the midshaft metacarpal and the midshaft radius correlated significantly with the whole bone density at all the other sites.

3. In the males these correlations were much less significant and no significant correlation was found between the whole bone density of either the metacarpal midshaft or the radial midshaft and that of the third lumbar vertebra or the distal femur, although a highly significant correlation was found between those of the distal femur and the lumbar vertebra.

4. It is suggested that in women, measurements of either mineral/unit length or whole bone density of both the midshaft metacarpal and radius provide useful information on the whole bone densities at other sites throughout the skeleton. This work was supported by the Scottish Hospital Endowments Research Trust, the National Fund for Research into Crippling Diseases and G. D. Searle and Co. Ltd., High Wycombe.