Caveat: hip fractures in the mentally deficient

Some hip fractures in mentally deficient patients are days to weeks old, are not painful, and can be treated nonoperatively. Despite current emphasis on reduction an internal fixation of femoral neck fractures, displaced fractures (Garden IV) in this group should not be nailed. Impacted neck fractures (Garden I) should be pinned in situ and the patient should ambulate immediately. Hemiarthroplasty is the treatment of choice for displaced intracapsular fractures in those previously ambulatory. Late pain is not a clinical problem. Extracapsular fractures should be reduced and nailed with a sliding device in a valgus position without medial displacement, and the patient should ambulate immediately. Extended hospital stays for the purpose of physical therapy should be avoided. These people should be returned as soon as possible to their previous environment where graduated mobilization should be encouraged.