Once a radiological diagnosis has been made, decisions about non-operative management can be taken.
For non-impacted intracapsular fractures, the best non-surgical care is to relieve pain and mobilize the patient despite the fracture. These fractures will not unite with non-surgical treatment and mobilization of the patient as a whole is of paramount importance.
If a radiological diagnosis is not available, the possibility of a displaced intracapsular fracture of the proximal femur may be suggested by external rotation with slight to moderate shortening (2.5 – 5 cm), which increases only slightly with proximally directed pressure on the leg. Non-operative treatment of such patients is not based upon bone healing, which, as noted, does not occur without surgical treatment. Traction can be omitted, or discontinued and the patient mobilized as soon as comfort permits.
If there is marked thigh shortening which increases progressively, or is associated with palpable bone deformity, the patient is more likely to have an extracapsular fracture with potential for healing. Patients with these injuries are reasonable candidates for 6-8 weeks of traction, as described below, followed by progressive ambulation, with delayed weightbearing, in hopes of avoiding excessive deformity.
For proximal femur fractures that are likely to be extracapsular (pertrochanteric or subtrochanteric), the non-operative regimen is as follows.