THE USEFULNESS OF LONG LENGTH FEMUR RADIOGRAPH IN PROXIMAL FEMUR FRACTURES

As part of the workup long length femur radiograph may be carried out pre-operatively in patients presenting with a proximal femur fracture in order to rule out distant metastasis in patients with a history of malignancy but also in some patients in whom a suspicion of possible distal abnormality is aroused by the configuration of the proximal fracture Using our unit’s database we identified all patients (n=689) presenting with a proximal femoral fracture between Sept 2006 and August 2007 at the Norfolk and Norwich University hospital in Norwich. Of 689 patients, 92 patients (13.2%) had long length femur radiograph performed before surgery. Indications included history of cancer (39), subtrochantric fractures (14), spontaneous fracture without any fall(2), paget s disease(1), early onset osteoporosis(1) while no clear indication was available in 35 patients. Five patients (5.5%) were found to have some abnormality. Three of the 39 patients with a history of previous cancer were found to have a distal femur metastasis. Two of the 35 patients where a clear indication was not apparent had abnormal findings: one patient had a distal femur infarction and another was found to have a distal femoral malunion. In both cases long leg films did not influence choice of implant. Of the 39 patients with a previous history of cancer, 24 had short implants (hemi-arthroplasty, intramedullary device, DHS), 14 had long implants and one patient died before the operation. Long length femoral radiographs appear to be indicated in patients with a documented history of a cancer as it helps to decide whether to use a long or short implant. However in patients without a history of malignancy, long leg films were of no value in decision making even if the configuration of the fracture was suspicious.