The Incidence and Outcomes of Patients with a Proximal Femur Fracture who are Treated Non-operatively

Hip fractures are a common occurrence and are treated with internal fixation or arthroplasty, depending on the type and displacement of the fracture. The goal of surgery is early mobilization and therefore almost all patients with a hip fracture are candidates for surgery. Only in rare cases do patients receive non-operative treatment.

In this study, we analyzed the database of a tertiary hospital for the period 2013–2019 in order to identify patients admitted with a hip fracture who did not undergo surgery. We examined the patient’s profile, the type of fracture, the reason for not performing surgery and the mortality rate.

Among 3,348 patients admitted with a proximal femur fracture, only 48 (1.43%) were treated non-operatively. They can be divided into two groups: patients with extreme operative risk and non-ambulatory patients with severe dementia. Of the 18 patients in the first group, 88% died within one month. Of the 30 patients in the second group, 96.7% had an intracapsular fracture and a one-year 30% mortality rate.

Surgery and its aftermath have both direct and indirect costs. The reasons for the decision not to operate, despite the fact that operating is the accepted clinical practice, are important to identify and understand. The results of this study can assist surgeons who are considering whether or not to operate on patients with a proximal femur fracture.