Authors' reply

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7061.879c (Published 05 October 1996) Cite this as: BMJ 1996;313:879
  1. S J Calder, Research registrar,
  2. P J Gregg, Professor,
  3. G H Anderson, Senior registrar
  1. University Department of Orthopaedic Surgery, Glenfield General Hospital, Leicester LE3 9QP
  2. Department of Orthopaedic Surgery, Leicester Royal Infirmary, Leicester LE1 5WW

    EDITOR,—G N Rutty and colleagues raise several points we would like to answer. How long after a hip fracture does death stop being related to that fracture? Our combined experience of well over 2000 prospectively documented hip fractures has convinced us that most deaths within four weeks are precipitated by the injury, and nowhere in our report did we state that we used this interval other than as a convenient cut off for our simple study. In fact, we stated this clearly in the first paragraph of the comment section.

    We agree that the practice of omitting the fracture from the death certificate should be condemned—a point that we thought was implicit in our paper. It does, however, happen—often, as shown by our findings, and usually after discussion between a junior doctor and the coroner's officer, and we should not pretend otherwise.

    There is no doubt that practice differs between coroners' offices across Britain. This point is well made in Martyn Parker's letter and is clear from the tone of the letter from Rutty and colleagues and by comments from other sources. We consulted the appropriate authorities in Leicestershire before reaching our conclusions. We also agree with Parker's comment about the distress caused to relatives. The idea that postmortem examination should be carried out in all cases, proposed by Ian S D Roberts and Emyr W Benbow, might be resisted by relatives for the same reason.

    Our study attempted to make the simple point that hip fracture is often omitted from death certificates for inappropriate reasons, thereby causing inaccuracies in official mortality statistics; this seems to have been missed by some readers, which may partly be due to the brevity of our report. Clearly, the medicolegal concepts relating to deaths soon after hip fractures have not been made clear to many junior medical staff and coroners' departments, and a smoother process might be beneficial for everyone.

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