‘SHOULD WE SEND THE HEAD?’ INCIDENCE OF PATHOLOGICAL NECK OF FEMUR FRACTURES: A ONE-YEAR RETROSPECTIVE OVERVIEW

Abstract

Neck of femur fracture (NOF#) is the commonest reason for admission to an orthopaedic ward with 70-75,000 cases each year in the UK1. The femoral head is often sent to pathology if there is clinical suspicion of a malignant cause. There is limited evidence in the literature to support the efficacy of this2. The purpose of this project was to study the incidence of femoral head pathology analysis in NOF # patients with a background of malignancy and evaluate the impact this investigation has on guiding future management.Retrospective analysis of all neck of femur fractures admitted to the Queen Elizabeth University Hospital between 01/01/2021 and 31/12/2021. The electronic notes were accessed and for patients with past medical history of malignancy, it was confirmed whether femoral head or bone reamings were sent to pathology, resultant findings and the impact on subsequent management.In 2021, 784 patients were admitted to the QEUH with a NOF#. Of these, 770 (98.2%) underwent operative management, 138 (17.3%) of whom had a past medical history (PMH) of malignancy. Intra-operative pathology was sent from 19 (13.7%) of these 138 patients. No malignant cells were found in 13 (69%) samples, and in 6 (31%), the known active malignancy was confirmed. In all cases where samples were sent for pathology, none caused any change in management.In this retrospective study, pathological investigations in NOF# patients with a PMH of malignancy had no impact on further management. The authors would not advocate for sending pathology results in this cohort group.