Fracture of the Femur in Old Age: A Two-Centre Study of Associated Clinical Factors and the Cause of the Fall

All patients with fractured neck of the femur admitted to hospitals in two areas (North London and Manchester) in a period of one year have been examined--a total of 384 patients. Compared to control groups of similar age, the older fracture patients showed a higher prevalence of chronic brain syndrome, they were in poorer physical state and their skinfold thickness was less. They also had more unrecognized visual disorders. Those who were younger had a higher prevalence of stroke than comparable controls. The type of fall leading to the fracture varied with age--tripping was the commonest cause in the younger patients the 'drop attacks' in the older. Both stroke and partial sightedness were associated with falls due to loss of balance. The older patients had a very high prevalence of pyramidal tract abnormality associated with chronic brain syndrome--and it appears that these demented patients fall not because of mental confusion but because of associated motor abnormalities. Extra-capsular fractures occur in older patients. They are more likely to have a history of falls but previous fracture is equally common at this age in the fracture and control series.