Outcomes of Non-operative Management of Neck of Femur Fracture: A Single Center Study

Objectives This study aimed to understand the incidence, demographics, inpatient stay duration, role of imaging and outcomes for patients diagnosed with neck of femur (NOF) fractures and managed non-operatively. Methods In this study, the data was collected retrospectively for 14 years (January 2009-January 2023). The inclusion criteria involved all non-operatively managed NOF fractures. The trauma board, electronic patient records, radiographs, and National Hip Fracture Database (NHFD) were used for the data collection. The data was collected as demographic details, fracture classification, any reasons for non-operative management, mortality and further surgical management. Patients who had surgery, died or transferred to other sites for specialist surgery were excluded. Results In our study, 1.5% (62/4132) of NOF fractures were managed non-operatively at our institution. The reasons for non-operative management were as follows: medically unwell patients (45.2%, n = 28) in whom operative risk was thought to outweigh benefit and risk of death was high within the 48-72 hrs of admission. The second group of patients had minimal or no pain and had old fractures with comfortable mobilisation (54.8%, n = 34). Out of 34/62 patients who were mobilised, 14.7% (5/34) of this patient subgroup subsequently required surgical intervention for failed non-operative management. In the medically unwell group (28/62), the 30-day mortality was 42.8% (12/28) with a 1-year mortality rate of 60.7% (17/28). The patients who were mobilised (34/62), the 30-day mortality was 11.8% (4/34), with a 1-year mortality rate of 14.7% (5/34). The combined average 1-year mortality for this cohort was 35.4% (22/62). Conclusions Our study showed a higher mortality rate for the medically unwell group (42%). Among patients with stable fractures that allowed comfortable mobilisation, the 1-year mortality rate was 20%. Additionally, 14% of these patients (5 out of 34) eventually required surgical intervention. We note that an analysis is necessary to assess the functional outcomes of this subgroup, as well as the potential cost implications. The combined average 1-year mortality for this cohort was 35% (22/62), which was due to the high-risk factors in the medically unwell group.