Non displaced femoral neck fractures of the oldest olds. Functional or orthopedic treatment: comparison is not right

Introduction: Elderly impacted valgus femoral neck fractures treatment is a non-solved problem. Morbidity and efficiency of functional treatment or of orthopedic treatment with their obvious innocuousness are a little reported.Methods: A prospective longitudinal study has studied the results of impacted valgus femoral neck fractures with functional treatment (strolling without weight bearing for 45 days) for 35 patients (83 ± 9 years). These results had been compared with those of orthopedic treatment (Böhler hip cast and strolling without weight bearing for 45 days) for 20 patients [20/45 (44%) of an impacted valgus neck fractures reference group (45% <70 years)]. After secondary displacement, a surgical treatment with hip arthroplasty was carried out.Results: Secondary displacement occurred in 23/35 (66%) of the patients of the functional treatment group: between day 3 and day 40, with a displacement rate function of the fracture grading (Garden I-Pauwels I: 63%, Garden I-Pauwels II: 75%, Garden II-Pauwels I: 75%, Garden II-Pauwels II: 100%) and occurred in 1/20 (5%) of the patients of the orthopedic treatment group.Conclusion: We have to reconsider the non-operative treatment of the elderly impacted valgus femoral neck fractures: either the functional treatment with a high secondary displacement rate (66%) even when success criteria are respected or the orthopedic treatment which is selective, demanding and reliable. The initial treatment failure increases morbidity and leads to a costly waiting period for a delayed healing. This economical and medical report may suggest giving up these treatments for these patients.