Data were extracted from patient records using a data collection form. Results Mean age of the population was 75.8 years and72.9% were females and 27% were males. Only four patients (11%) had surgery within the recommended period of 48 hours after admission. 50% of patients had surgery only after 7-8 days. Delays were compounded by late admission to hospital following injury. One patient died of a probable acute coronary event or pulmonary embolism. Lack of close monitoring of these patients due to inadequate intensive care beds, complicates the postoperative management. None of these patients received thrombo-prophylaxis despite current guidelines. Conclusions and Recommendations Adherence to standard practice guidelines for management of patients with fracture neck of femur is found to be unsatisfactory at CNTH, Ragama. The delays are due to late admission, late referral to orthopaedic team and anaesthetists and lack of dedicated theatre time and intensive care beds. Thromboprophylaxis in this high risk category of patients is not carried out. There is an urgent need to address these issues and plan perioperative management of these patients according to available standard practice guidelines.