The non-operative treatment of impacted femoral neck fractures

In a prospective study, 319 impacted femoral neck fractures (IFNF) were treated functionally by early mobilization. The overall mortality at one year was 19%. Of the 311 fractures which were followed up until healing or secondary instability (SI), 216 fractures (69%) united. Instability occurred mainly in patients over 70 years of age, and in younger patients with a short life expectancy or disabling neurological disease. Only 5% of the healthy younger patients suffered SI. Stepwise logistic regression analysis indicated that poor general health and age over 70 were highly significant risk factors. None of the other variables, such as Garden index or Pauwels type had any significant influence on the development of SI. Delayed operation after SI caused no increase in mortality, nonunion or avascular necrosis. Functional treatment of all IFNF's, except in patients over 70 years of age with multiple co-morbidity, seems therefore to be justified.