Challenging the dogma to 'always operate' acute hip fractures: a proof-of-concept pilot study for nonoperative management of undisplaced femoral neck fractures

BackgroundThe notion that all acute hip fractures are a surgical entity requiring either surgical fracture fixation or hip replacement represents a historic dogma, particularly within the orthopaedic community of the United States. The present study from a European regional trauma center was designed to challenge the notion that stable and undisplaced femoral neck fractures represent an absolute indication for surgical management.MethodsThe purpose of this study was to investigate the hypothesis that stable and undisplaced femoral neck fractures of the Garden types 1 and 2 can be safely managed nonoperatively. A retrospective observational cohort study was carried out at a regional orthopaedic trauma center in Germany from January 1, 2016 to June 30, 2021. The inclusion criteria specified patients older than 18 years suffering a ResultsA total of 41 undisplaced femoral neck fractures (Garden types 1 and 2) were included in this study;n = 20 were in the resulting admission operatively treated (group 1) andn = 21 were treated conservatively. The mean age in group 1 was 76 years; women (70%). In group 2 it was 81 years with a female dominance (71.4%). Admission status: Garden types 1 and 2, group 1n = 13/7 and group 2n = 15/6. Subsequent femoral neck fracture displacement (Y/N) (in case of operation, before operation) group 1n = 14/6 and group 2n = 6/15.ConclusionAccording with our results, patients sustaining Garden type 1 femoral neck fractures, depending on age and comorbidities, should be treated conservatively with weight bearing and under physiotherapeutic instructions. In case of femoral neck fractures Garden type 2, a surgical treatment should be performed in order to avoid femoral neck fractures to slip after weight bearing by lacking of fracture impaction.