Minerva Orthopedics · Nov 2026
Mortality and clinical outcomes in conservatively treated patients with proximal femur fractures: a retrospective observational study
By Goderecci R, CASCHERA GG, Aloisi G et al.
BACKGROUND: Proximal femur fractures are a leading cause of morbidity and mortality among older adults. While surgical treatment is generally recommended, a subset of frail patients may be deemed unsuitable for surgery. This study aimed to evaluate survival and functional outcomes in elderly patients with proximal femur fractures managed non-operatively.METHODS: We conducted a retrospective, single-center observational study including 42 patients aged ≥65 years treated conservatively for fragility fractures of the proximal femur between January 2021 and December 2023. Clinical, laboratory, radiographic, and functional data were extracted from medical documentation routinely collected during standard care. Primary outcome was overall mortality at last available follow-up (defined as the last clinical evaluation or death). Secondary outcomes included pain (Visual Analogue Scale, VAS), functional independence (Barthel Index), complications, and hospital stay. Survival analyses were performed using Kaplan-Meier estimates.RESULTS: At a mean follow-up of 247.5 days, 22 patients (52.4%) had died. Infections (40.5%) and secondary displacement or non-union (35.7%) were the most frequent complications. Functional independence significantly declined over time, with mean Barthel Index reducing from 70.5 prefracture to 27.3 at follow-up. Survivors were younger, had higher BMI, lower pain scores, and better autonomy than non-survivors (P<0.05). Kaplan-Meier analysis showed significantly lower survival in patients with fracture displacement or non-union (mean 176 vs. 573 days, P=0.028).CONCLUSIONS: Conservative management of proximal femur fractures in frail elderly patients is associated with high mortality and progressive functional decline. When surgical treatment is not feasible, clinicians should anticipate reduced independence, higher complication rates, and increased care needs. These aspects should be clearly addressed with patients and families to support informed and shared decision-making.