What is the prognosis for non-displaced femoral neck fractures treated with a strict protocol? Analysis of a prospective cohort treated with internal fixation versus arthroplasty.

Introduction Non-displaced femoral neck fractures (FNF) are common in elderly patients, but the best treatment approach is still uncertain. The decision should be based on several factors, including fracture angulation and comminution, to ensure the best possible clinical and functional outcomes in the mid-to long-term. In this study, we report on the treatment of non-displaced FNF in elderly patients using a personalized protocol with either internal fixation or arthroplasty. Our objectives were to evaluate the clinical and functional outcomes of both treatment options and to compare the results between the two groups. Methods Analysis of a prospectively collected cohort of patients treated from 2010 to 2022 with a geriatric non-displaced femoral neck fracture. Patients were treated with internal fixation if no significant angulation, cortical gap, comminution, or significant osteoarthritis was observed. In case any of the later was present, a joint replacement was selected. Primary outcomes recorded were complications, reoperations, and mortality. Results One hundred and nineteen patients were included. 75% were female. Nintynine patients were treated with internal fixation, while eighteen had a partial or total hip replacement. Two patients did not undergo surgery because of their general condition. Patients were followed for a median of 4 years. Severe complications were observed in 5% of cases, while reoperations were performed in 4%. 30-day mortality and one-year mortality were 1% and 6%, respectively. There were no significant differences in reoperations, complications, or mortality between the internal fixation group and the arthroplasty group. Conclusions Surgical management of non-displaced femoral neck fractures with internal fixation or arthroplasty is both safe and effective as long as a strict protocol is followed, and careful analysis of radiographic features is performed.