Abstract
The outcome of patients with a displaced intracapsular femoral neck fracture treated
non-operatively was assessed at 1 year and compared with patients managed operatively
over the same time period. Data were collected prospectively for 102 consecutive patients.
80 patients underwent hemiarthroplasty and 22 were managed non-operatively. Patients
were managed non-operatively if they were felt to have an unacceptably high risk of
death within the perioperative period despite medical optimisation. Non-operative
management entailed active early mobilisation without bed rest or traction.
Patients managed non-operatively had a greater 30-day mortality compared with operatively
managed patients. Deaths were due to pre-existing medical conditions or events, which
had occurred at the time of hip fracture. No patient in the non-operative treatment
group developed pneumonia, pressure sores or thrombo-embolic events. Patients treated
non-operatively, who survived 30 days after fracture, had a mortality rate over the
following year comparable with those who had undergone surgery.
At 1 year, all non-operatively managed patients were able to transfer without pain
and 6 of the 11 surviving patients were able to mobilise with walking aids. At 1 year,
the majority of surviving non-operatively managed patients were living in their own
homes.
Surgical intervention is the treatment of choice for the majority of elderly patients
with a displaced intracapsular femoral neck fracture. However, in patients with life-threatening
medical co-morbidity, non-operative treatment with early mobilisation can yield acceptable
results.
Keywords
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Article info
Publication history
Accepted:
June 15,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
