BMJ  2004;328:1568 (26 June), doi:10.1136/bmj.328.7455.1568

Letter

Implementing guidance on hip fracture

Advice is misleading

The first 150 words of the full text of this article appear below.

EDITOR—Dr Foster's case notes by Bottle et al quote the Scottish Intercollegiate Guidelines Network (SIGN) recommendation that patients with fractured neck of femur are operated on as soon as possible, ideally within 48 hours after admission.¹

Patients with femoral neck fracture who are fit on admission are usually operated on early. Those who are not have their medical conditions treated and a later operation. The fit group do better than the unfit group, hence time to operation merely reflects general fitness on admission. The timing of operation does not itself cause the difference in mortality.

In a study performed in Newcastle all patients who were fit enough, or could be made fit enough, were treated surgically.² A point was made of treating concurrent medical problems, particularly dehydration and chest infection before operation was undertaken. The overall six month mortality of the group was 17%, and the six month . . . [Full text of this article]

Cumberland Infirmary, Carlisle, Cumbria CA2 2HY keith@gkions.fsnet.co.uk

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