Hip fracture : Treatment

Hip fractures are usually treated in hospital with surgery.

Most people will need surgery to fix the fracture or replace all or part of their hip, ideally on the same day they're admitted to hospital, or the day after.

There are different operations, which are described below. The type of surgery you have will depend on:

  • the type of fracture you have – where in the thigh bone (femur) the fracture is
  • your age
  • how physically mobile you were before the hip fracture
  • your mental ability to take part in the post-surgery rehabilitation programme
  • the condition of the bone and joint – for example, whether or not you have arthritis

Internal fixation

Internal fixation is when pins, screws, rods or plates are used to hold the bone in place while it heals.

It tends to be used for either:

  • a fracture outside the socket of the hip joint (extracapsular fracture)
  • a fracture inside the socket of the hip joint (intracapsular fracture) – if it is stable and has not moved significantly (undisplaced)

If internal fixation is used for an intracapsular fracture, you'll have follow-up appointments over several months with X-rays to check it is healing well.

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Hemiarthroplasty

Hemiarthroplasty is when the femoral head is replaced with a prosthesis (false part). The femoral head is the rounded top part of the thigh bone (femur) that sits in the hip socket.

This procedure is often the preferred option for an intracapsular fracture (inside the socket of the hip joint), in someone who already had reduced mobility before the fracture.

In this type of fracture, a replacement is the preferred option.

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Complete hip replacement

A complete hip replacement is an operation to replace both the socket in the hip and the rounded top part of the thigh bone (femoral head) with a prosthesis (false part).

This is a more major operation than hemiarthroplasty and is not necessary in most patients, but may be considered if you already have a condition that affects your joints, such as arthritis, or you're very active.

Find out more about hip replacement.

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Pre-operative assessment

If you're in a stable condition, you'll ideally have surgery within 48 hours of arriving at hospital.

You'll have a pre-operative assessment to check your overall health and make sure you're ready for surgery.

During your assessment you'll be asked about any medicines you're currently taking, and any necessary tests and investigations will be done.

You'll also have an anaesthetic assessment to decide what type of anaesthesia to use. Different types include:

  • spinal or epidural anaesthesia – used to numb the nerves in the lower half of your body so you will be awake but you will not feel anything
  • general anaesthetic – which puts you to sleep so you cannot feel anything

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Before surgery

Hip fractures can be very painful. During diagnosis and treatment, you should be given medicine to ease your pain. At first, pain relief is usually given through a needle into a vein in your arm (intravenously), with a local anaesthetic injection near the hip.

Surgery carries the risk of a blood clot forming in a vein, so steps will be taken to reduce this risk. For example, you may have injections of heparin, which is an anticoagulant that reduces the blood's ability to clot.

You'll continue to be monitored for blood clots during your stay in hospital. You may still need medicine after you're discharged.

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Your operation

The operation may take a couple of hours.

If you have any questions about your operation, ask your surgeon or another member of your care team.

After the operation, you'll begin your rehabilitation programme. This may take place in a different ward to the one where you had surgery.

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It may also be useful to read our guide to social care and support – written for people with care and support needs, as well as carers and families.

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Conservative treatment

Conservative treatment is the alternative to surgery. It involves a long period of bed rest and is not often used because it can:

  • make people more unwell in the long-term
  • involve a longer stay in hospital
  • slow down recovery

However, conservative treatment may be necessary if surgery is not possible – for example, if someone is too frail to cope with surgery, or if they did not go to hospital straight after the fracture happened and it has already started to heal.

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Osteoporosis

Hip fractures often happen in people with osteoporosis (weak and fragile bones). You should be assessed for osteoporosis during your hospital stay.

If you have osteoporosis or you have a high risk of developing it, you'll be treated for this while you are in hospital.

Find out more about treating osteoporosis.

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