[Translated article] Non-operative management in intracapsular hip fractures. General characteristics in a...

Non-surgical management of intracapsular hip fractures is rare and reserved for fragile patients with comorbidities 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.