Delayed diagnosis of femoral-neck fractures in the elderly

A survey of a district population presenting to a trauma unit with fractured femoral necks over a year, showed that, out of a total of 374 elderly patients with this fracture, in 33 the diagnosis was delayed for over 24 hours from the onset of disabling symptoms. This was due to late presentation in eight patients, difficulty in confirming the suspected diagnosis in five, and in 20 to initial failure of doctors to make the diagnosis. By comparing this latter group with controls, it was found that medical error was most likely in patients who were either confused, dependent and subject to falls, or alternatively had suffered a spontaneous fracture which had not displaced.