Femoral Head Histology in Subcapital Fractures: Efficiency and Cost Effective

Background:
Osteoporotic fractures present a major health care and financial problem worldwide. Substantial portion of these fractures being femoral neck fractures, which are treated by surgery in most cases. It is common practice nowadays in many medical institutions to routinely conduct a pathology examination on resected femoral head specimens.

The aim of this study is to assess the cost effectiveness and screening reliability of routine postoperative femoral head pathology examination.

Methods:
A retrospective study was conducted of electronic medical records in a university-affiliated, tertiary care hospital from 2015-2018. 230 patients with subcapital fracture who underwent surgical treatment, and with available postoperative femoral head pathological examination. Collected data included patients` demographics, background diagnosis and specifically neoplastic disease, and postoperative pathological examination results.

Results:
The mean age was 82.4±14.1 years. 62.1% were women. 72 (31%) patients were presented with past or active malignancy during the time of the operation. Most patients (85%) underwent partial hip arthroplasty. Of the 230 patients in this study with postoperative femoral head pathology examination, 8 (0.03%) were positive for malignancy. Of them, all 8 (100%) patients had a current, active malignancy during the time of the fracture and operation. The most common pathologies were breast cancer (40%) and multiple myeloma (40%).

Conclusions:
Pathology examinations of femoral head specimens extracted from patients who sustained subcapital femoral fractures did not change the medical management in any of 230 consecutive cases and was thereby found of very low value as a routine screening test.