A prospective study of 142 consecutive patients admitted with fracture of the neck of femur was performed. 42 patients were operated within 24 hours of time of fracture (group 1), 46 within 24 to 48 hours (group 2) and 47 more than 48 hours later (group 3). Three patients were treated conservatively and in four patients the exact time of fracture was not known.

The reason for delay of the operation was lack of theatre space in the majority of cases (64 patients). Medical problems accounted for delay in only 10 patients.Seven patients out of 42 in group 1 died within four month (16.7%), compared to 11 of 46 in group 2 (23.9%), and 6 out of 47 in group 3 (12.8%). This difference was not statistically significant.

There was no significant difference in requirement for pre- and postoperative blood transfusion between the three groups. No patient operated within 24 hours developed pressure sores. Three patients in group 2, and six patients in group 3 developed pressure sores. Chest infections occurred in three patients in group 2, and in three patients in group 3. None of the patients operated on within 24 hours developed a chest infection, wound infection or urinary tract infection. Two patients who had a Girdlestone procedure for deep infection were operated more than 48 hours after the fracture. One patient requiring drainage for wound infection had the operation 47 hours after the fracture.There were no superficial or deep wound infections, pressure sores, or chest infections if operated on within 24 hours of fracture. There was no difference in the requirement for blood transfusion. Patients operated within 24 to 48 hours of fracture had the highest mortality, although this was not statistically significant.