Review Question - QID 103026

This patient is very old, has many medical comorbities, and is non-ambulatory at baseline. For this reason, she is not a candidate for surgery and would likely die during the procedure thus making rehabilitation and pain management the optimal management for this patient.

Hip fractures are common in elderly patients. While appropriately managing pain is an important component in the treatment of all hip fractures, surgery is indicated for patients who are ambulatory and stable, regardless of age. Patients who are non-ambulatory or have medical problems precluding surgery should be treated with pain management alone. The patient's goals of care and expected clinical course should also be taken into consideration. If the patient is likely to not survive surgery or the rehabilitation process after surgery, then pain management is the most important treatment for these patients.

Incorrect Answers:
Answer 1: Casting is appropriate management of a reduced fracture that requires being immobilized. Generally, most fractures can be reduced and splinted which has similar outcomes with decreased risks (in terms of swelling leading to damage in a cast).

Answer 2: Hip prosthesis is the optimal management of a femoral neck fracture in an elderly patient who is healthy enough to handle the operation and recovery process. Untreated femoral neck fractures have an extremely high mortality; however, this patient is elderly and has many medical comorbidities that making an aggressive surgical procedure unlikely to be helpful and more likely to cause death.

Answer 3: Pinning is the optimal treatment of an intertrochanteric fracture but not of a femoral neck fracture.

Answer 4: Reduction and splinting is appropriate management of a distal radius fracture. If reduction results in a well-aligned fracture the patient can often be spared from surgery.

Bullet Summary:
Very ill patients who are not ambulatory are often not candidates for surgical repair of femoral neck fractures.