Neck of femur fracture: Previous history of malignancy is not an indication to send femoral head for routine histology
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Neck of femur fractures is the most common fractures associated with low-velocity injury in the elderly. Some patients may require further histological examination of the femoral head due clinical suspicion of malignance as a cause of fracture.
To review whether standard screening question(s) could be used to identify patients that require histological examinations following neck of femur fracture.
Study design and methods
Femoral heads sent for histological examination over a period of 5 years were identified from hospital database. All patients presenting acutely with neck of femur fracture above the age of 70 were included, and their case notes were retrospectively reviewed. Reason for histopathological examination were categorised into three screening questions: (Q1) clinical suspicion based on history alone, i.e. neck of femur fracture with no clear history of fall or trauma or preceding hip pain, (Q2) radiological evidence of suspicious abnormality on admission radiographs, (Q3) previous history of malignancy or concurrent malignancy or (Q4) combination of above.
In total, 119 samples of femoral head were sent and 18 patients had a positive histology. The sensitivity and specificity of these questions individually showed very poor correlation to positive histology with lowest for (Q3) previous history of malignancy (0.39 and 0.51, respectively). However, combining Q1 and Q2 the sensitivity is improved to 1.0 (95% CI 1.0–1.0) and specificity to 0.35 (95% CI 0.25–0.44) with a positive predictive value of 0.21 (95% CI 0.13–0.30) and negative predictive value of 1.00 (95% CI 1.00–1.00).
History of previous malignancy poorly correlates with positive histology. Routine request based on these screening criteria is not cost-effective in patient management.
Level of evidence
Prognostic level III.
KeywordsNeck of femur fracture Malignant Histopathological examination Bone tumour Hemiarthroplasty Femoral head Screening questions Sensitivity specificity Cancer treatment Survival
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All applicable international, national and/or institutional guidelines for the care and use of animals were followed. This article does not contain any studies with human participants or animals performed by any of the authors. Data used in this study were within the approval of hospital ethical standards.
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