Neck of femur fracture medical therapy

	Neck of femur fracture Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

The mainstay of treatment for neck of femur fracture is surgery. Non-operative management is reserved for a very small proportion of patients.

Medical Therapy

Conservative management with derotational cast Source: Case courtesy of Ashashyou [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0), from Wikimedia Commons]

The mainstay of treatment for neck of femur fracture is surgery. Non-operative management is reserved for a very small proportion of patients.^[1]^[2]^[3]^[4]^[5]

Non-operative Treatment

Indications

Non-ambulators
Patients with minimal pain
Patients who are at high risk for surgical intervention

Techniques

Derotational cast
Traction

Complications

Osteonecrosis
Non union
Complications Of Prolonged Recumbency such as:
- Hypostatic pneumonia
- Pressure sores
- Deep venous thrombosis
- Pulmonary embolism
- Cardiac failure due to weakening of the cardiac muscle and poor venous return
- Muscle wasting
- Common peroneal nerve palsy
- Stiffening of joints
- Osteoporosis
- Urinary tract infections
- Depression

References

↑ Faraj AA (2008). "Non-operative treatment of elderly patients with femoral neck fracture". Acta Orthop Belg. 74 (5): 627–9. PMID 19058696.
↑ Moulton LS, Green NL, Sudahar T, Makwana NK, Whittaker JP (2015). "Outcome after conservatively managed intracapsular fractures of the femoral neck". Ann R Coll Surg Engl. 97 (4): 279–82. doi:10.1308/003588415X14181254788809. PMC 4473865. PMID 26263935.
↑ Handoll HH, Parker MJ (2008). "Conservative versus operative treatment for hip fractures in adults". Cochrane Database Syst Rev (3): CD000337. doi:10.1002/14651858.CD000337.pub2. PMID 18646065.
↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

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[pmid19058696-1] Faraj AA (2008). "Non-operative treatment of elderly patients with femoral neck fracture". Acta Orthop Belg. 74 (5): 627–9. PMID 19058696.

[pmid26263935-2] Moulton LS, Green NL, Sudahar T, Makwana NK, Whittaker JP (2015). "Outcome after conservatively managed intracapsular fractures of the femoral neck". Ann R Coll Surg Engl. 97 (4): 279–82. doi:10.1308/003588415X14181254788809. PMC 4473865. PMID 26263935.

[pmid18646065-3] Handoll HH, Parker MJ (2008). "Conservative versus operative treatment for hip fractures in adults". Cochrane Database Syst Rev (3): CD000337. doi:10.1002/14651858.CD000337.pub2. PMID 18646065.

[4] Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.

[5] Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

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