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Hip fracture in the 1930s.

Nowadays, fracture of the neck of femur is one of the risks of old age, especially for elderly women. It is a major public health problem in many Western countries and an increasing challenge in the developing world. The number of hip fractures around the world is projected to rise from 1.6 million in 1990 to 6.26 million by the middle of the next century [1]. These fractures are at least in part avoidable by preventing and treating osteoporosis and by preventing falls [2, 3]. In the developed countries, when an unfortunate elder does fall and suffer a broken hip, she is usually operated on as soon as possible. With optimum preand post-operative care and careful attention to the principles of geriatric rehabilitation, many of those who lived at home before the fracture will return to their pre-operative lifestyle and functional level. This approach has not always been the case. Documentation of this can be found in the pages of the British Medical Journal from the 1930s. At that time, general anaesthesia, aseptic surgical technique and the principles of post-operative rehabilitation were already well known, after the medical experience of the massive numbers of trauma victims of the First World War. However, elderly hip fracture patients did not routinely undergo surgery. In a letter entitled ‘‘Fracture of femur in a woman of 80’’ [4], the surgeon W. B. R. Monteith wrote: