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.