Abstract
Purpose
In the UK, it is common practice to obtain full-length femur radiographs in patients admitted with neck of femur fractures (NOF) and co-existing malignancy. Limited literature exists studying this topic. Our aim was to identify whether full-length femur radiographs are of diagnostic and therapeutic value in this demographic.
Methods
A retrospective observational analysis of the patients admitted with a neck of femur fracture over a 5-year period (2015–2020) using the National Hip Fracture Database was performed at a major trauma centre. Electronic patient records were accessed to screen the NOF patients who had co-existing malignancy and subsequently underwent a full-length femur radiograph. In addition to patient demographics, we also identified the plan and whether it was affected by findings of the full-length radiograph, the operation performed, any additional investigations undertaken for malignancy, the type of cancer, complications and 1-year mortality.
Results
Of the 2416 patients screened, 18% had a co-existing malignancy (n = 431). Of the 431 with underlying malignancy, 424 patients underwent a full-length femur radiograph while only seven of these radiographs identified lesions. From the seven patients with findings of metastatic deposits on full-length radiographs, none required an alternative operation to that which they normally would undergo. Furthermore, no patients required a longer stem arthroplasty or longer internal fixation. One in four fractures was associated with co-existing breast malignancy (26.5%, n = 114), followed by prostate cancer (14.8%, n = 64). Colorectal, lung, bladder and skin (squamous cell carcinoma) contributed 6–10% (n = 44, 40, 33, 29, respectively). Other malignancies contributed to the rest of the 25%.
Conclusion
To conclude, full-length radiographs had no diagnostic or therapeutic value in our cohort of patients regardless of the full-length femur findings.
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Ghobrial, M., Vaidya, A., Thahir, A. et al. Diagnostic value of full-length femur radiographs in patients with neck of femur fracture and co-existing malignancy. Eur J Orthop Surg Traumatol 33, 347–352 (2023). https://doi.org/10.1007/s00590-021-03190-y
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DOI: https://doi.org/10.1007/s00590-021-03190-y