A great deal of attention has been devoted to the ever-increasing incidence of fractures of the proximal femur in elderly patients and the impact which this has had upon their life expectancy and quality of life. The condition has also made heavy demands on the Health Service, and much effort has been devoted to increasing hospital throughput by effective programmes of rehabilitation. In these circumstances, it is not surprising that much less has been written about the issues involved in treating elderly patients with less serious forms of fracture. Nonetheless, closer attention to this group reveals that it also makes heavy demands on the Health Service. An example is that, in 1995, out of 1771 elderly patients admitted to the acute orthopaedic wards at Edinburgh Royal Infirmary, only 47% had fractures related to the proximal femur or displacement of a hip prosthesis (Figure 1) (CT Currie, unpublished data, 1996). Most of the remainder had fractures at other sites, while 8% had soft tissue injuries. The percentage of fractures involving more common sites in old people was 2.5% for the neck of humerus, 3% for the shaft of humerus, and 7% for the wrist. The low proportion of vertebral fractures emphasizes that this condition rarely leads to admission to an acute unit, so that the size of the problem is usually underemphasized.