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  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section


Theerachai Apivatthakakul, Jong-Keon Oh

Executive Editor

Michael Baumgaertner

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1. General considerations

Treatment guidelines

Depression of the femoral head with a chondral lesion or impaction fracture will be treated by observation.

Close follow-up is mandatory to identify posttraumatic arthritis or avascular necrosis.

In case of secondary osteoarthritis that involves the weight-bearing area, arthroplasty should be considered.

Mobilization with crutches of hip fracture patients

2. Skin traction

Skin traction on the leg for a few days may be used for pain relief.

Use about 2 kg of weight over the end of the bed for traction.

Straight skin traction with weight over the end of the bed for preliminary treatment of femoral fractures

3. Mobilization

Dislocation precautions

Since most femoral head fractures are associated with a hip dislocation, precautions against redislocation should be taken for the first 6 weeks after injury.

Low seats and toilets, flexing the hip when arising, sitting with legs crossed, as well as squatting and kneeling may also be avoided initially, as should pivoting on the affected leg. The patient and caregivers may be encouraged to use additional support when rising from a sitting position.

Patient mobilization

Weight bearing as tolerated is allowed with walking aids.

Range-of-motion exercises should start cautiously in the immediate postoperative period to prevent stiffness while avoiding dislocation.

Weight bearing as tolerated with walking aids after treatment of proximal femoral fractures

Pain control

To facilitate rehabilitation and prevent delirium, it is important to control the postoperative pain properly, eg, with a specific nerve block.

VTE prophylaxis

Patients with lower extremity fractures requiring treatment require deep vein prophylaxis.

The type and duration depend on VTE risk stratification.


Follow-up assessment for wound healing, neurologic status, function, and patient education should occur within 10–14 days.

Check the condition of the injury with appropriate x-rays at six weeks.

Longer follow-up, at 6 months and 1 year, is indicated to assess the development of posttraumatic arthritis and/or avascular necrosis.

Prognosis of proximal femoral fractures in elderly patients

For prognosis in elderly patients, see the corresponding additional material.