Refining the indications for surgery after proximal femoral fracture

Many patients die shortly after surgery for proximal femoral fracture. These patients are subjected to painful operative procedures that do not improve their outcome. We attempted to identify such patients with a case-controlled study of variables associated with death in hospital after proximal femoral fracture. Bronchopneumonia, ASA grade 4, heart failure and malnutrition were significantly associated with death but the latter two variables alone were insufficiently specific to justify withholding surgical treatment. However, 90% of patients with bronchopneumonia and those deemed unfit for anaesthesia died shortly after admission and their condition was not improved by active intervention. We suggest that it is kinder to withhold early surgery in this population.