Hip Fractures
Understanding one of the most serious fractures in older adults, from surgical decisions to recovery and prevention.
Types of Hip Fractures
Where the femur breaks determines the blood supply risk, treatment approach, and long-term outcome. Understanding the fracture type is the first step in surgical planning.
Femoral Neck Fracture
Intracapsular / Inside the joint capsule
The femoral neck connects the ball of the hip to the shaft of the thighbone. A fracture here disrupts the blood vessels that supply the femoral head, creating a significant risk of avascular necrosis, where the bone tissue dies from lack of blood flow. Displaced femoral neck fractures in older adults typically require hip replacement rather than repair.
High risk: Avascular necrosisIntertrochanteric Fracture
Extracapsular / Between the greater and lesser trochanters
The most common type of hip fracture in elderly adults. Because these fractures occur outside the joint capsule, the blood supply to the femoral head remains intact. This means the bone can generally heal if it is properly stabilized with surgical hardware. Most intertrochanteric fractures are treated with a sliding hip screw or intramedullary nail.
Good blood supply: Usually repairableSubtrochanteric Fracture
Below the lesser trochanter / Upper femoral shaft
Less common than the other types, subtrochanteric fractures occur in the thick cortical bone below the trochanters. In younger patients, these often result from high-energy trauma. In older adults, they may be associated with long-term bisphosphonate use (atypical femur fractures). These fractures experience high mechanical stress and typically require an intramedullary nail for fixation.
Watch: Bisphosphonate-related atypical fracturesSurgical Options by Fracture Type
The right procedure depends on fracture location, displacement, bone quality, and patient activity level. Surgery within 24-48 hours of the fracture is associated with better outcomes.
| Procedure | How It Works | Best For | Recovery |
|---|---|---|---|
|
Hip Pinning / Screws
Preserves natural hip
|
Multiple screws are placed across the fracture line to hold the bone fragments together while they heal. | Non-displaced femoral neck fractures where the bone pieces have not shifted out of position. | Weight-bearing as tolerated. Healing in 3-4 months. Risk of screw failure or non-union in older bone. |
|
Sliding Hip Screw
Gold standard for stable IT
|
A large screw is placed into the femoral head and attached to a metal plate along the outside of the femur. The screw slides within the plate as the fracture compresses during healing. | Stable intertrochanteric fractures (two-part fractures with intact lateral wall). | Immediate partial weight-bearing. Most patients walk with a frame within days of surgery. |
|
Intramedullary Nail
Unstable or subtrochanteric
|
A metal rod is inserted into the hollow center of the femur with screws extending into the femoral head. Provides internal support along the length of the bone. | Unstable intertrochanteric fractures, reverse oblique patterns, and all subtrochanteric fractures. | Immediate weight-bearing in most cases. Minimally invasive insertion point. Strong fixation. |
|
Hemiarthroplasty
Displaced femoral neck, lower demand
|
The femoral head is replaced with a metal prosthesis while the natural hip socket (acetabulum) is preserved. | Displaced femoral neck fractures in older, lower-activity patients. Eliminates risk of non-union. | Full weight-bearing from day one. Shorter operation. Lower dislocation risk than total replacement. |
|
Total Hip Replacement
Active patients, displaced neck
|
Both the femoral head and the hip socket are replaced with prosthetic components. The most complete reconstruction. | Active, independent patients with displaced femoral neck fractures and pre-existing hip arthritis. | Full weight-bearing from day one. Better long-term function and lower reoperation rate versus hemiarthroplasty. |
Recovery Timeline After Hip Fracture
Recovery from a hip fracture is a months-long process with distinct phases. Understanding what to expect at each stage helps patients and families plan ahead.
Preventing Hip Fractures in Seniors
Most hip fractures are preventable. A combination of fall prevention, bone strengthening, and home safety modifications can significantly reduce risk.
Fall Prevention Strategies
- Exercise programs focused on balance and strength, such as tai chi
- Regular vision checks and updated corrective lenses
- Medication review to identify drugs that cause dizziness or drowsiness
- Proper footwear with non-slip soles, both indoors and out
- Standing up slowly to avoid lightheadedness from blood pressure drops
Hip Protector Pads
- Wearable padded undergarments that absorb impact during a fall
- Most effective for nursing home residents at high fall risk
- Adherence is the main challenge, so comfort and fit matter
- Available as hard-shell or soft-foam designs
- Shown to reduce fracture risk in institutional settings
Osteoporosis Treatment
- Bone density screening (DEXA scan) for women over 65 and men over 70
- Calcium (1,200 mg daily) and vitamin D (800-1,000 IU daily) supplementation
- Prescription medications such as bisphosphonates, denosumab, or teriparatide
- Weight-bearing exercise to maintain bone density
- Regular follow-up to monitor treatment response
Home Safety Modifications
- Grab bars in bathrooms near the toilet and in the shower
- Removal of throw rugs and loose cords from walkways
- Night lights in hallways, bedrooms, and bathrooms
- Non-slip mats in the bathtub and on kitchen floors
- Rearranging frequently used items to avoid reaching or bending
Caregiver Guide: After Discharge
Caring for a loved one after hip fracture surgery is demanding but critical for recovery. Here is what to expect and how to prepare.
What to Expect at Home
Follow-Up Schedule
Essential Equipment
Related Resources
This content is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Hip fractures require emergency medical care. Always consult a qualified orthopedic surgeon or healthcare provider for guidance specific to your situation. If you or a loved one has fallen and cannot bear weight on the leg, call emergency services immediately.