Hip fracture: what the patient and the family need to know

What a hip fracture is

The term means a break at the top end of the thigh bone, close to the joint. There are two main types:

• Femoral neck fracture. It happens inside the joint and can cut off the blood supply to the head of the femur.
• Intertrochanteric fracture. It happens a little lower, outside the joint, in bone with a good blood supply.

The type of fracture decides the type of operation.

How to recognise it

• Sharp pain in the groin or buttock after a fall.
• Not being able to get up or put weight on the leg.
• The leg often looks shorter and turned outwards.

Do not try to stand the person up. Call 166 (or 112). The diagnosis is made with an X-ray. Rarely, a fracture that has not shifted does not show, and a CT or MRI scan is needed.

Why surgery is done quickly

A hip fracture does not wait. While the patient stays in bed, the risk of pneumonia, blood clots, pressure sores and confusion rises. That is why international guidelines advise that surgery takes place, where possible, within 24 to 48 hours.

In the meantime the heart specialist and the anaesthetist carry out the necessary checks, and drugs such as blood thinners are adjusted. The aim is a safe operation without needless delay.

Fixation or replacement?

• Fixation. The fracture is held with a nail inside the bone or with screws. It is the usual choice for intertrochanteric fractures and for neck fractures that have not shifted.
• Hemiarthroplasty. Only the head of the femur is replaced. Preferred for displaced neck fractures in patients with limited mobility.
• Total hip replacement. In more active patients with a displaced neck fracture, it often gives better function in the long run.

In 2023 Dr Skotidis published a review on dislocation after total hip replacement in older patients with a femoral neck fracture. In it, the anterior approach was linked to a lower dislocation rate. Read more about hip replacement with the anterior approach.

The first days after surgery

The aim is for the patient to sit and stand on the very next day, with the physiotherapist. In most cases weight can go through the leg from the start.

At an older age, a passing spell of confusion in the first days is common. Familiar faces, the patient’s own glasses and hearing aids, daylight and good sleep at night all help a great deal.

Recovery

Getting back to walking takes weeks to months, and depends mostly on how mobile the person was before the fracture. Physiotherapy continues at home or in a rehabilitation centre, depending on the support available.

Good nutrition, with enough protein, and daily movement matter as much as the operation itself.

Preventing the next fracture

A hip fracture after a simple fall almost always means osteoporosis. Anyone who has had one is at higher risk of a second. That is why treatment does not end with the operation.

• Testing and treating osteoporosis, with a bone density scan and the right medication.
• Enough vitamin D and calcium.
• Balance and strength exercises.
• A safe home: good lighting, no loose rugs, grab rails in the bathroom.
• A check of eyesight and of any medication that causes dizziness.

What the family can do

• Bring the list of the patient’s medication and conditions to the hospital.
• Stay close in the first days. It reduces confusion.
• Encourage movement and eating, even when the mood is low.
• Prepare the home before the return.
• Ask about osteoporosis treatment before discharge.

Common questions