Detecting injury to the heart after emergency orthopaedic surgery by means of a blood test (called Troponin I) and determining if care by the cardiology unit can improve mortality at one year compared to usual care

All recruited patients will have troponin blood tests and electrocardiographs (ECGs) done on post-operative days 1,2 and 3. Patients with a post-operative troponin rise will then be randomised to either standard care or cardiology care (the intervention). The cardiology care protocol involves a "total package" of care. This involves transfer to the coronary care unit for 24hours, review by a cardiologist and consideration for catheterisation if symptomatic. If not for catheterisation or if asymptomatic cardiology treatment will involve medical management with aspirin, beta blocker, statin +/- Angiotensin Converting Enzyme (ACE) inhibitor. All medications will be given orally with the dose and frequency at the discretion of the cardiologist. Duration of medication treatment will be for at least the duration of hospitalization with ongoing medication treatment at the discretion of the cardiologist. Patients randomised to coronary care will also have cardiac investigations including serial ECGs, chest x-ray, lipid profile, echocardiogram. All patients randomised to coronary care will also receive outpatient follow up by a cardiologist and a functional cardiac study (either dobutamine stress echocardiography or thallium stress test, only if they are a candidate for catheterisation in the future).