Non-operative management in intracapsular hip fractures. General characteristics in a single-center series

Non-surgical management of intracapsular hip fractures is rare and reserved for fragile patients with co-morbidities that contraindicate surgery. The aim of the study is to determine the mortality rate in intracapsular hip fractures managed non-surgically.

Retrospective series of patients who received non-surgical management between January 2004 and December 2023 included, minimum follow-up 1 year. Periprosthetics or secondary-to-tumor fractures, polytraumatized and surgically treated intracapsular hip fractures were excluded. Mortality was recorded during admission, at 30 days, 6 months and one year.

Non-surgical management was indicated in 54 patients (frequency 7.56%), the most common reason was low functionality (Barthel index <20 points) associated with non-ambulation and/or neurological disease/dementia. Two patients were excluded due to loss of follow-up. During admission, 3 patients died (5.8%), at 30 days 8 patients (15.4%), at 6 months 23 patients had died (44.2%) and in the first year 30 patients (57. 7%). It was observed that the deceased patients were older (mean age 89.7 years versus 83 years); and association between mortality at one year and Barthel index (p: 0.019) and mobility 30 days after the fracture (p: 0.006).

We present a high one-year mortality (57.7%), higher than published for surgery, so we believe that in fragile patients we must either improve multidisciplinary outpatient follow-up or consider other palliative care, without reaching harsh therapeutic treatment.