Results of early and delayed surgical fixation of hip fractures in the elderly: a comparative retrospective study.

The postoperative course of 555 elderly patients with fractures of the femoral neck was reviewed. Of these, 89% were surgically treated within 24 hours following injury and the remaining within 2-7 days. The postoperative results of patients who underwent reconstructive surgery within 24 hours were significantly better than of those treated later. The overall immediate postoperative mortality in these surgically treated patients was 1.6%, whereas in 56 patients who were treated conservatively the mortality rate was 8.9%. This markedly low mortality was observed in spite of a high percentage of associated diseases in 71.2% of the surgically treated patients. These findings suggest that whenever possible, immediate or early reconstructive surgery of femoral neck fractures in the elderly is the preferred treatment of choice. Early surgical intervention should be pursued and performed following immediate medical evaluation, even in the presence of multiple associated diseases. The contraindication to surgical treatment must be well defined and kept to a bare minimum, since conservative treatment appears to bear a high mortality risk in geriatric patients.