Surgery or palliation for hip fractures in patients with advanced malignancy?

OBJECTIVE to investigate the management and outcome of patients with advanced cancer who sustain fractures of the neck of femur. DESIGN multi-centre, prospective, observational study. SUBJECTS patients with advanced malignancy, under the care of a palliative care team, who subsequently fractured a femur. OUTCOME MEASURES survival time post-fracture, return home. RESULTS 40 patients were recruited with a fractured neck of femur. Analysis of the management of patients according to the Eastern Co-operative Oncology Group performance score was undertaken. Twenty-nine patients were treated surgically and 11 conservatively. For patients with performance scores of 0, 1 and 2 surgery usually resulted in a successful rehabilitation outcome and discharge. None of those with scores of 3 or 4 returned home. CONCLUSION patients with advanced malignancy and a poor performance score should not be automatically referred for surgery.