Delayed diagnosis of femoral neck fractures.

To determine the causes and consequences of any delay from the onset of symptoms to diagnosis, 1108 consecutive patients with an acute proximal femoral fracture were prospectively studied. In 154 cases (13.9 per cent) the diagnosis was delayed more than 24 h from the onset of symptoms. The reason for this was due to failure to seek medical help in 63 patients. For the 91 patients who were seen by a medical practioner, 60 were not X-rayed straight away. For those cases where a radiographic examination was requested, the fracture was invisible in only nine cases, of which six subsequently displaced. The diagnosis was more likely to be delayed if the fracture occurred spontaneously, the patient fell inside, or the fracture was intracapsular. Delay in diagnosis was not associated with an increase in mortality but there was a significant increase in the risk of pressure sores.