The objective was to study patients of Aboriginal and Torres Strait Islander origin who were admitted to Cairns Base Hospital with the diagnosis of femoral neck fracture. An analysis of all 232 admissions with this diagnosis between November 1997 and July 2000 was carried out. Information was gathered from data accumulated on the Clinical Pathways database; other local data was also considered. Patients registered as being of Aboriginal and Torres Strait Islander origin have a lower incidence of these fractures than might be expected on an overall population basis, but similar rates on age-standardised data. The female age profile is substantially older than the female non-indigenous osteoporotic fracture group. Indigenous females develop osteoporotic type fractures of the femoral neck at a later age than do non-indigenous females. This may reflect a genetic difference in bone mineral density or a healthy lifestyle in earlier days. Further research is suggested.

Clinical pathways are being increasingly used for daily patient care. The pathways consist of a sequence of critical treatment events matched to the patient's recovery. Variance analysis identifies deviations from the pathway and can be used for quality improvement and clinical audit. The aim of this study is to analyse the variances from clinical pathways in two common elective orthopaedic operations. A prospective variance analysis was performed from the clinical pathways of all patients undergoing total hip and total knee arthroplasty over a 12 month period. Variances were categorised according to their source and then further divided into serious and non-serious variances. A total of 65 patients underwent total knee replacement during the study. Eleven serious variances were recorded in eight of these patients (12.3%) with a surprisingly high number of cardiac events. A total of 52 patients underwent total hip replacement with nine serious variances recorded in seven of these patients (13.5%). Clinical pathways can be used as a means of incorporating evidence-based medicine into clinical practice. Variance analysis of the pathways can be utilised as a process of quality control and to improve patient outcomes. Serious variances within this study were higher than anticipated.

The objective was to study patients of Aboriginal and Torres Strait Islander origin who were admitted to Cairns Base Hospital with the diagnosis of femoral neck fracture. An analysis of all 232 admissions with this diagnosis between November 1997 and July 2000 was carried out. Information was gathered from data accumulated on the Clinical Pathways database; other local data was also considered. Patients registered as being of Aboriginal and Torres Strait Islander origin have a lower incidence of these fractures than might be expected on an overall population basis, but similar rates on age-standardised data. The female age profile is substantially older than the female non-indigenous osteoporotic fracture group. Indigenous females develop osteoporotic type fractures of the femoral neck at a later age than do non-indigenous females. This may reflect a genetic difference in bone mineral density or a healthy lifestyle in earlier days. Further research is suggested.