Objective-To assess the management of elderly patients presenting to the accident and emergency (A&E) department with a proximal femoral fracture. Methods-A retrospective audit carried out on 30 patients with proximal femoral fracture showed an unacceptably long waiting time in the A&E department. A new "fast track" system for managing these patients, involving the use of a flow chart for expediting admission, was devised. A prospective study of 100 patients > 60 years of age with proximal femoral fracture admitted by fast track system was then carried out.

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In view of the authors' decision to apply only part of the Ottawa ankle rules, and the disregard for one of the malleoli, it seems inappropriate to conclude that "although useful, decision rules should be used with care and cannot replace clinical judgment and experience".

Letters, CD-ROM review 75 better if we are to proactively manage this demand to the benefit of the patient, the ambulance service, and the wider NHS.