Surgery or palliation for hip fractures in patients with advanced malignancy?
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1Princess Alice Hospice, Esher, Surrey, UK.
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.
