Paper| Volume 26, ISSUE 4, P237-240, May 1995

Death after proximal femoral fracture—an autopsy study

      This paper is only available as a PDF. To read, Please Download here.


      We reviewed 22 486 consecutive autopsy reports in a single District General Hospital, from 1953 to 1992. Five hundred and eighty-one patients with fractures of the proximal femur (hip fracture) were identified. Causes of death were correlated with timing of surgery and change of clinical practice. Thromboembolic and haemorrhagic potential were analysed. The principal causes of death after hip fracture were bronchopneumonia, cardiac failure, myocardial infarction and pulmonary embolism. Surgical intervention, within 24h of injury significantly reduced death from bronchopneumonia and pulmonary embolism. Early mobilization reduced death from bronchopneumonia. Pulmonary embolism may be reduced by prophylactic anticoagulation, but 17 per cent of patients are at risk of haemorrhage, and mechanical methods seem safer in this population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Raine GET
        A comparison of internal fixation and prosthetic replacement for recent displaced subcapital fractures of the neck of the femur.
        Injury. 1973–1974; 5: 25
        • Hunter GA
        A comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur.
        Br J Surg. 1969; 56: 229
        • Bannister GC
        • Gibson AG
        • Ackroyd CE
        • et al.
        The fixation and prognosis of trochanteric fractures; a randomised prospective controlled trial.
        Clin Orthop. 1990; 254: 242
        • Garcia Jr, A
        • Neer II, CS
        • Ambrose GB
        Displaced intracapsular fractures of the neck of the femur: 1. Mortality and morbidity.
        J Trauma. 1961; 1: 128
        • Gordon PC
        The probability of death following a fracture of the hip.
        Can Med Assoc J. 1971; 105: 47
        • Ions KG
        • Stevens J
        Prediction of survival in patients with femoral neck fractures.
        J Bone Joint Surg [Br]. 1987; 69B: 384
        • Britton M
        Diagnostic errors discovered autopsy.
        Acta Med Scand. 1974; 196: 203
        • Goldman L
        • Sayson R
        • Robbins S
        • et al.
        The value of the autopsy in three medical eras.
        New Engl J Med. 1983; 308: 1000
        • Battle RM
        • Pathak D
        • Humble CD
        • et al.
        Factors influencing discrepancies between premortem and post-mortem diagnosis.
        JAMA. 1987; 258: 339
        • Beals RK
        Survival following hip fracture: long follow-up of 607 patients.
        J Chron Dis. 1972; 25: 235
        • Holmberg S
        • Conradi P
        • Kalen R
        • et al.
        Mortality after cervical hip fracture.
        Acta Orthop Scand. 1986; 57: 8
        • Bergqvist D
        • Fredin H
        Pulmonary embolism and mortality in patients with fractured hips: a prospective consecutive series.
        Eur J Surg. 1991; 157: 571
        • Schroder HM
        • Andreassen M
        Autopsy verified major pulmonary embolism after hip fracture.
        Clin Orthop. 1993; 293: 196
        • Sevitt S
        • Gallagher NG
        Prevention of venous thrombosis and pulmonary embolism in injured patients.
        Lancet. 1959; ii: 981
        • Borgstrom S
        • Greltz T
        • Van Der Linden W
        • et al.
        Antico-agulant prophylaxis of venous thrombosis in patients with fractured neck of femur: a controlled clinical trial using venous phlebography.
        Acta Chir Scand. 1965; 129: 500
      1. Salzman EW, Harris WH and DeSanctis RW. Antico-agulation for prevention of thromboembolism following fractures of the hip. New Engl J Med275: 122.

        • Morris GK
        • Mitchell JRA
        Warfarin sodium in prevention of deep venous thrombosis and pulmonary embolism in patients with fractured neck of femur.
        Lancet. 1976; ii: 869
        • Galasko CSB
        • Edwards DH
        • D'A. Fearn CB
        • et al.
        The value of low dose heparin for the prophylaxis of thromboembolism in patients with transcervical and intertrochanteric fractures.
        Acta orthop Scand. 1976; 47: 276
        • Morris GK
        • Mitchell JRA
        Preventing venous thromboembolism in elderly patients with hip fractures: studies of low dose heparin, dipyridamole, aspirin and flurbiprofen.
        Br Med J. 1972; i: 535
        • Monreal M
        • Lafoz E
        • Navarro A
        • et al.
        A prospective double blind trial of low molecular weight heparin once daily compared with conventional low dose heparin three times daily to prevent pulmonary embolism and venous thrombosis in patients with hip fracture.
        J Trauma. 1989; 29 (1989): 873
        • Jorgensen PS
        • Knudsen JB
        • Broeng L
        • et al.
        The thromboprophylactic effect of a low molecular weight (Fragmin) in hip fracture surgery.
        Clin Orthop. 1992; 278: 95
        • Ahlberg A
        • Nylander G
        • Robertson B
        • et al.
        Dextran in prophylaxis of thrombosis in fractures of the hip.
        Acta Chir Scand. 1968; 387 (suppl): 83
        • Edwards DH
        • Steel WM
        • Bentley G
        Prophylaxis with dextran 70 against thrombosis in patients with fractures of the upper end of the femur.
        Injury. 1975; 6: 250
        • Stranks GJ
        • MacKenzie NA
        • Grover ML
        • et al.
        The A-V impulse system reduces deep vein thrombosis and swelling after hemiarthroplasty for hip fracture.
        J Bone Joint Surg [Br]. 1992; 74B: 775