Two internists have recently championed the non-operative, nonacute-care hospital management of demented nonambulatory elderly patients with proximal femoral fractures. They believe that superior care is thereby provided at lower cost and chances for survival improve. This article describes the problems encountered in applying nonoperative management to such patients in a different geographical setting, including the lack of accurate information about prefracture function, drastic alterations in patient health and function during transfers between institutions, difficulty even in recognizing fractures, the indefinite persistence of some pain, and lack of unanimity among treating professionals. Nonoperative management still remains a desirable option for truly nonambulatory, demented, aged patients with proximal femoral fracture. Triage should be done in the chronic care institution, but only by professionals who know the individual.
* Associate Professor, Department of Orthopedics, University of Colorado School of Medicine, and Chief, Orthopedic Service, Veterans Administration Hospital, Denver, Colorado.