Femoral Head Histology – When is This Test Useful?

Description

In a recent presentation, Mohammad Al-Ashqar discusses a study conducted in North Yorkshire examining the necessity and clinical implications of sending femoral heads to histology after neck of femur fractures. He humorously remarks on dressing up for the opportunity, noting that this was his first time wearing a tie since the pandemic. The study involved 376 samples over three years across five hospitals, focusing on whether histological evaluations impacted clinical management, particularly concerning malignancy indications. Al-Ashqar outlines the lengthy and costly procedures associated with histological analysis, which often yields results 29 days post-sample submission.



He presents key findings: only 12% of submitted samples showed malignancy, but only 5% represented the first diagnosis of malignant disease, indicating that most cases were already known. Al-Ashqar emphasizes that only a small percentage (3.7%) had clinical management altered directly as a result of histology findings, with the majority of patients either dying before results arrived or being in palliative care.



The presentation also discusses predictive factors for malignancy, noting pre-injury pain substantially increased risk, while prior malignancy alone was a less reliable indicator. Al-Ashqar concludes that due to 96% of cases not affecting clinical management significantly, a more selective approach is warranted when deciding to send samples for analysis. Cost analysis reveals substantial financial implications of current practices, with an extrapolated cost of over £135,000 across the study period due to the resources involved in decalcification and histopathological examinations.



Overall, the discussion prompts a reevaluation of current protocols, suggesting potential conversations with oncologists and reconsideration of the criteria for sending femoral heads to histology.

DOI: 10.1302/3114-221596

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