RESULTS OF CONSERVATIVE TREATMENT FOLLOWING HIP FRACTURE COMPARED TO SURGICAL INTERVENTION

Abstract

Introduction: We prospectively followed all hip fracture patients admitted between 2004–2006, identified cases where the intention was to treat conservatively and compared their functional outcome and mortality with a similar cohort treated surgically over the same period.

Methods: We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 day and 1 yr mortality, re-admission and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post fracture mobility, mental confusion and independence with the conservatively treated group.

Results: 25 patients were treated conservatively. 22 patients treated surgically over the same period were recruited. The mean hospital stay was 13 days in both groups. There were 4 extracapsular (3 displaced) and 21 intracapsular fractures (5 displaced) in the conservative arm and 11 extracapsular and 9 intracapsular fractures in the surgically treated arm. 4 patients from the conservative treatment group underwent late surgery 20 days – 2 months after the index event. Surgically treated group had 11 dynamic screw fixation, 1 cannulated screw, 1 total hip replacement and 7 hemiarthroplasty. 9/14 of the conservatively treated patients were mobile independently or with aid after treatment compared to 11/16 patients after surgery. 7/16 patients treated conservatively were living independently in their own residence, compared to 10/14 patients in the operatively treated patients. 1 month and 1 year mortality in conservatively treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05).

Discussion: Conservative management after hip fracture in medically unfit patients does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically.