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Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%–19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60–101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality.

Inductively Coupled Plasma – Mass Spectroscopy (ICP-MS) was used to monitor urinary selenium, copper and zinc in a group of Bangladeshi (n = 54), Indian (n = 25), Pakistani (n = 21), and White Caucasian (n = 23) volunteers living in the UK. The most striking findings were far higher urinary copper levels (P < 0.001) in the Bangladeshi group (median: 30.2 μg Cu/l) compared to other ethnicities (15.6 μg Cu/l, Pakistani; 14.8 μg Cu/l, Indian; 10.5 μg Cu/l, Caucasians) and to reference values reported for the UK population. Although no significant difference was found for Zn (P = 0.22; medians: 430 μg Zn/l for Bangladeshis, 377 μg Zn/l for Pakistani, 350 μg Zn/l for Caucasians, 355 μg Zn/l for Indians), a significantly (P < 0.001) higher Cu:Zn ratio was found for the Bangladeshis. Urinary Se of Bangladeshis (17.6 μg Se/l) was significantly (P < 0.001) higher compared to Indians (13.8 μg Se/l) and Pakistani (4.1 μg Se/l), although urinary selenium was generally within the reported reference values reported for the UK population. Exposure to copper via ethnic food consumption or altered copper metabolism may contribute to higher levels of Cu and Cu:Zn ratio in the Bangladeshi group. Previous studies have correlated high serum copper levels to cardiovascular diseases (CVD), liver cirrhosis, chronic hepatitis and hepatocellular carcinoma (HCC). Bangladeshis have higher than UK average mortality from HCC and a disproportionately higher incidence of CVD. The high urinary Cu levels and Cu:Zn ratio detected in UK Bangladeshis may therefore reflect early onset of disease process, and may ultimately result in these conditions for members of the Bangladeshi community.