Hip Fracture

What to do right after a fall

• Do not try to lift the person to their feet if they have hip pain or cannot bear weight. Call 911 or your local emergency number.
• Keep them warm with a blanket and comfortable where they lie. Put a pillow under the head if the neck is not hurt.
• Do not give food or drink, as surgery may be soon.
• Note how they fell, whether they hit their head or blacked out, and what medicines they take, especially blood thinners.

If you live alone, a personal alarm or a phone you keep on you means you will not lie on the floor for hours, which causes dehydration, muscle breakdown and pressure sores.

Symptoms of a broken hip

• Severe pain in the outer hip or groin pain, sometimes felt in the thigh or knee
• Inability to stand or walk, or extreme pain bearing weight
• A leg that looks shorter, with the foot and knee turned outward
• Bruising and swelling around the hip (often appears later)
• Pain when trying to lift the heel off the bed or roll the leg

Some people, especially with an impacted fracture where the bone ends are jammed together, can still walk with a limp. Hip pain after any fall in an older adult should be X-rayed.

Types of hip fracture

Displaced femoral neck fractures often tear the blood supply to the ball, so the bone may not heal or may collapse. That is why replacement is preferred for them in older adults.

Causes and risk factors

More than 90% of hip fractures in older adults result from a fall, usually from standing height. Risk is highest with:

• Osteoporosis: low bone density means a simple fall can break the hip.
• Age over 65, and female sex
• Previous fractures, especially of the wrist, spine or other hip
• Fall risks: poor balance, muscle weakness, vision problems, dementia, Parkinson's disease and stroke. See falls in older adults for a fuller list.
• Medicines that cause dizziness or drowsiness, such as sleeping pills, sedatives and some blood pressure drugs, and long-term steroid use
• Low body weight, smoking and heavy alcohol use

In younger people, hip fractures usually need high-energy trauma such as a road crash. Runners and military recruits can develop femoral neck stress fractures from repeated loading.

Diagnosis

X-rays of the hip and pelvis confirm most fractures. If the X-ray looks normal but pain and difficulty walking persist, an MRI (or CT if MRI is unavailable) finds hidden (occult) fractures. Before surgery, doctors check blood counts, kidney function, an ECG and the reason for the fall, such as a heart rhythm problem or infection.

Treatment

Surgery

Surgery is the standard treatment for nearly all hip fractures because it relieves pain and lets you walk again quickly. Guidelines recommend operating within 24 to 48 hours of admission, once the person is medically stable. Delays raise the risk of complications and death. The type of operation depends on the fracture (see the table above), bone quality and how active the person was before the fall.

Nonsurgical treatment is reserved for people too unwell for anesthesia or already unable to walk, and it carries a high risk of complications from long bed rest.

In hospital

• Nerve block injections and regular pain relief
• Getting out of bed and standing the day after surgery
• Blood-thinning injections and early movement to prevent deep vein thrombosis
• Watching for delirium, which affects many older adults after hip fracture
• Care of the skin, bladder and bowels, and nutrition support

Hip fracture recovery timeline

Many people regain their previous walking ability, but a significant number need more help at home than before, especially if they had dementia or limited mobility already.

Complications

• Blood clots in the leg or lungs
• Pneumonia and urinary tract infections
• Delirium and loss of independence
• Pressure sores
• Implant failure, dislocation of a hip replacement, or the bone not healing (nonunion) or the ball collapsing (avascular necrosis)

Hip fracture is a serious event for older adults, with a substantially raised risk of death in the following year, largely from the underlying frailty and complications. Fast surgery, early mobilization and joint care by orthopedic and geriatric teams improve survival.

Preventing a hip fracture

• Treat osteoporosis: after any hip fracture, ask about a bone density test and bone-strengthening medicine, which lowers the chance of breaking the other hip.
• Exercise: balance and strength training such as tai chi reduces falls.
• Make the home safer: remove loose rugs and clutter, add grab bars, night lights and stair rails.
• Review medicines that cause dizziness or drowsiness.
• Check vision and footwear.
• Calcium and vitamin D in the diet, with supplements if intake is low, as advised by your doctor.
• Hip protectors may help people in care homes who fall often.

Frequently asked questions

What are the signs of a broken hip?

The main signs are severe pain in the hip or groin after a fall, being unable to stand or walk, and a leg that looks shorter and turned outward. Bruising and swelling may develop later. Some people with a small, impacted fracture can still walk, so pain after a fall needs an X-ray.

Can you walk with a fractured hip?

Usually not, but it is possible with an impacted or stress fracture, often with a painful limp. Walking on an unrecognized fracture can make it displace, turning a simple screw repair into a joint replacement. Get an X-ray for any new hip or groin pain after a fall.

How long does it take to recover from hip fracture surgery?

Most people stand the day after surgery and go home or to rehabilitation within a week or two. Bone heals in about 3 months, and most strength and independence return over 3 to 6 months. Improvement can continue for up to a year with regular exercise.

Why is a hip fracture so serious in older adults?

Older adults often have other illnesses, and the fracture forces bed rest, which leads to clots, pneumonia, delirium, pressure sores and muscle loss. Many do not regain their previous independence. Prompt surgery and early walking reduce these risks substantially.

Is hip fracture surgery always necessary?

Almost always. Surgery controls pain and lets you move again quickly, which prevents bed rest complications. Very occasionally, for someone too unwell for anesthesia or already bedbound, doctors and families choose pain control and nursing care instead.