[Garden I femoral neck fractures: conservative vs operative therapy]

Treatment recommendations vary for Garden I fractures of the proximal femur. The aim of our retrospective study was to determine the results of functional treatment of these injuries.

A total of 54 consecutive patients were enrolled, and their data (age, comorbidities, treatment, complications, etc.) were ascertained and stored in a database. Initial treatment consisted in early mobilization and weight bearing in all patients.

In 24 cases (44%) no complications at all were observed in the course of conservative treatment. In 28 cases (52%) surgical treatment was necessary due to early fracture dislocation. Analysis of the X-ray images showed that in 9 of these 28 cases the functional treatment had not been clearly indicated, i.e., incomplete impaction of the fragments. When these patients are excluded the success rate of conservative treatment was 53%, as two additional late complications occurred and were treated surgically (1x AVN, 1x nonunion). With reference to the survival rate, score, and patient satisfaction, there was no difference between conservative and operative treatment (p=0.478). The risk of a secondary dislocation increases with the number of risk factors (p=0.008).

An attempt at functional treatment with close X-ray monitoring is appropriate in these fractures, since this makes it possible to avoid surgery in about half of the patients while achieving functional results comparable to those yielded by surgery.