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Excised Femoral Heads in Hip Fracture Patients: Is Osteoporosis Worse Than Cancer?

Salar, Omer; Crosswell, Sebastien; Ghani, Rafia; Rao, Prasad; Meyer, Carl; Hay, Stuart; Ford, David; Mangham, Charles; Cool, Paul

Authors

Omer Salar

Sebastien Crosswell

Rafia Ghani

Prasad Rao

Carl Meyer

Stuart Hay

David Ford

Charles Mangham



Abstract

Introduction
Annually 80,000 hip fractures are treated at an estimated cost of two billion pounds. The 2011 guidance from the Royal College of Pathologists recommended all specimens where there is fracture through or below the articular surface should be examined to exclude/ identify an underlying cause (pathological fracture). The questions posed in this study are three-fold. Firstly, how does our practice for hip fracture patients comply with the above audit standards? Secondly, what is the prognostic significance of a past medical history of malignancy on survival? Thirdly, is there any other prognostic survival difference attributable to the diagnosis concluded from the histological analysis of the excised femoral head specimens?

Methods
A retrospective analysis of all hip fractures receiving joint arthroplasty was undertaken between January 2011 and March 2014. Mortality was recorded for a minimum follow-up of 30 months post-operatively. Each excised femoral head was histologically examined by a single consultant histopathologist, and all pre-operative X-rays were reviewed by a consultant radiologist. Histological diagnoses were recorded, and statistical analysis including Kaplan-Meier survival was performed.

Results
A total of 327 consecutive fractures were identified. Out of 187 specimens sent for analysis, only two revealed metastatic deposits in patients with known disseminated malignancy. A previous medical history of malignancy did not confer a significant increase in mortality over a five-year postoperative period (p = 0.42). A histological diagnosis of osteoporosis significantly increased mortality over a five-year postoperative period (p = 0.004). A comparative analysis found that patients with a histological diagnosis of osteoporosis had the poorest survival.

Conclusion
A histological femoral head analysis may diagnose previously undiagnosed osteoporosis, allowing the clinician to intervene in a disease process, which if left untreated, can lead to a significant increase in mortality.

Citation

Salar, O., Crosswell, S., Ghani, R., Rao, P., Meyer, C., Hay, S., …Cool, P. (2019). Excised Femoral Heads in Hip Fracture Patients: Is Osteoporosis Worse Than Cancer?. Cureus, 11(12), Article e6455. https://doi.org/10.7759/cureus.6455

Journal Article Type Article
Publication Date Dec 23, 2019
Deposit Date Jun 13, 2023
Journal Cureus
Print ISSN 2168-8184
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 11
Issue 12
Article Number e6455
DOI https://doi.org/10.7759/cureus.6455
Keywords General Medicine