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Introduction Fractured neck of femur (NOF) is a cause of significant morbidity and mortality. Approximately 4% of patients with an initial normal hip x-ray in the emergency department (ED) will in fact have an occult fracture. In cases where there is ongoing clinical suspicion of NOF fracture despite a normal hip x-ray, alternative imaging should be used. Although available evidence supports the use of magnetic resonance imaging (MRI) for this, it is often not readily accessible from the ED. In our department, it is common practice to request computed tomography (CT). Methods A historical review was undertaken of all patients who presented between October 2007 and January 2011 who had CT requested by ED staff. Patients included in the study were those who presented following low impact trauma in whom fractured NOF was suspected despite a normal x-ray. Results Of the 65 included patients, fractures (pelvic and hip) were identified in 38 patients on CT. Fractured NOFs were found in 13 patients. Acetabular fractures were found in nine patients, five of whom required further orthopaedic management. One patient went on to have MRI to confirm the diagnosis of an impacted NOF fracture, suspected both on x-ray and CT. Further review was undertaken of the medical notes of discharged patients to identify any who reattended or required further imaging. No such cases were found. Conclusions This review has shown the use of CT to be a practical approach to improving the care of patients with occult hip fractures.

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Due to their high speed and versatility, laser processing systems are now commonplace in many industrial production lines. However, as the need to reduce the environmental impact from the manufacturing industry becomes more urgent, there is the opportunity to evaluate laser processing systems to identify opportunities to improve energy efficiencies and thus reduce their carbon footprint. While other researchers have studied laser processing, the majority of previous work on laser systems has focused on the beam–material interaction, overlooking the whole system viewpoint and the significance of support equipment. In this work, a methodical approach is taken to design a set of energy modelling terminologies and develop a structured power metering system for laser systems. A 300 W fibre laser welding system is used to demonstrate the application of the power characterization system by utilizing a purpose-built power meter. The laser is broken down according to sub-system, with each part analysed separately to give a complete overall power analysis, including all auxiliary units. The results show that the greatest opportunities for efficiency improvements lie in the auxiliary units that support the laser devices as these were responsible for a majority of the electrical draw; 63.1% when the laser was operated at 240 W, and increasing as the beam power reduced. The remaining power draw was largely apportioned to electrical supply inefficiencies. In this work, the laser device delivered a maximum of 6% of the total system power. The implications of these results on laser processing system design are then discussed as is the suitability of the characterization process for use by industry on a range of specific laser processing systems.