From the Guidelines
Some femoral neck fractures can be managed non-operatively, particularly non-displaced or minimally displaced fractures in elderly patients with low functional demands or significant comorbidities. Non-operative management of femoral neck fractures typically involves bed rest initially, followed by protected weight-bearing using a walker or crutches for 6-12 weeks, as seen in the management of other types of fractures 1. Pain management includes acetaminophen (up to 3000mg daily in divided doses), NSAIDs if not contraindicated, and possibly short-term opioids for breakthrough pain. Regular radiographic follow-up is essential at 1-2 week intervals initially to ensure the fracture doesn't displace. Physical therapy is crucial to maintain muscle strength and joint mobility. However, non-operative management carries risks including fracture displacement, nonunion, and complications of prolonged immobility. The decision to treat non-operatively must carefully balance these risks against surgical risks, considering the patient's overall health status, functional needs, and preferences, as outlined in recent guidelines 1. Most femoral neck fractures in younger patients and displaced fractures in patients of any age typically require surgical intervention. Key considerations in the decision-making process include the patient's age, comorbidities, level of function, and underlying conditions, such as osteoarthritis, which may influence the choice of treatment, including total hip arthroplasty (THA) or hemiarthroplasty 1. Ultimately, the management of femoral neck fractures should prioritize minimizing morbidity, mortality, and optimizing quality of life, with a careful assessment of the benefits and risks of operative versus non-operative management.
From the Research
Femoral Neck Fractures Management
- Some femoral neck fractures can be managed non-operatively, although the provided studies do not directly address this topic, they discuss the management of other types of fractures, such as atypical femoral fractures and fragility fractures.
- The decision to manage a femoral neck fracture non-operatively depends on various factors, including the patient's overall health, the severity of the fracture, and the presence of any underlying medical conditions 2, 3, 4, 5, 6.
Types of Fractures
- Atypical femoral fractures are a type of fracture that occurs in the femur, typically in patients who have been taking bisphosphonates for an extended period 2, 6.
- Fragility fractures, on the other hand, are fractures that occur in patients with osteoporosis or other conditions that weaken the bones 3, 4.
Treatment Options
- Surgical treatment is often necessary for atypical femoral fractures, as they can be challenging to manage and have a high risk of complications 2, 6.
- Non-operative management may be considered for some patients with fragility fractures, although this depends on the individual patient's circumstances 3, 4.
Patient Factors
- Patient factors, such as age, overall health, and presence of underlying medical conditions, can influence the decision to manage a fracture non-operatively or operatively 5.
- The patient's body mass index (BMI) and American Society of Anesthesiologists (ASA) class can also impact the decision to perform surgery in a freestanding ambulatory center or a hospital setting 5.