Care of the elderly patient following surgery for a fracture of the proximal femur.

A short postal questionnaire was sent to all practising orthopaedic surgeons in the United Kingdom, to determine the current pattern of post-operative care for patients with a fracture of the proximal femur, and to determine the current contribution to care being undertaken by geriatricians. This paper presents the responses of 616 orthopaedic surgeons who are actively involved in the care of patients with a fracture of the proximal femur. For the patient who had been partially dependent on family and social services before injury, and thus had most to benefit from an effective rehabilitation, there was a diversity of care on offer. Sixty-three per cent of surgeons stated that this category of patient was routinely cared for on an acute orthopaedic ward; 36% regularly transferred such patients to rehabilitation units, which were geriatric units in 18% of cases, 'second line' orthopaedic beds in 9% of cases and orthogeriatric units in a further 9% of cases. Surgeons who regularly transferred patients to designated rehabilitation units were more satisfied than those whose patient care took place in the environment of the acute orthopaedic ward. Eighty per cent of surgeons were satisfied with orthogeriatric units, and 62% were satisfied with transfer of patients to units supervised by geriatricians. By contrast, only 17% of surgeons were satisfied with a system of care in which geriatricians were available for consultation by written request only. The specialties of orthopaedic surgery and geriatric medicine have a vital role to play in the post-operative care of patients, and a combined effort to address this issue should be made.