Full-length radiographs of the femur in patients with a femoral neck fracture and co-existent malignancy--are they of benefit?

It is recommended that full-length femoral radiographs should be obtained in patients presenting with a femoral neck fracture and a co-existent history of malignancy. Over a two-year period, we identified 133 (47 males, 86 females) patients admitted with a femoral neck fracture and a co-existent history of malignant disease, representing 6.5% of all femoral neck fractures admitted within this time frame. None of the patients had previously diagnosed bone metastases. The mean patient age was 80 years (range, 30-97 years). In 114 cases the fracture was traumatic in origin, most commonly a simple fall (86%). In 19 cases the fracture was atraumatic with histopathological analysis demonstrating the presence of bony metastases. Overall, breast (35%), lower gastrointestinal (22%), prostatic (18%) and bronchogenic carcinomas (7%) were the most common associated malignancies. On reviewing the full-length anteroposterior and lateral femoral radiographs, none of the patients had demonstrable pathology in the remainder of the femur. Furthermore, none of the patients to date have required readmission with a secondary fracture relating to disease in the middle or distal thirds of their femur. We conclude that full-length views of the femur are of limited value in patients presenting with a femoral neck fracture and a co-existent history of malignant disease.