A hip fracture is a serious break in the upper part of the thighbone that requires immediate medical attention and, almost always, surgery. Treatment focuses on repairing the bone through surgery, preventing serious complications, managing pain, and helping patients regain as much mobility and independence as possible through rehabilitation.

When a Fall Changes Everything

Each year, more than 300,000 people in the United States experience a hip fracture, and most of them are adults aged 65 or older^[1]. While younger individuals can break their hip during high-energy events like car accidents or falls from significant heights, the vast majority of hip fractures happen because of simple household falls in elderly people whose bones have been weakened by osteoporosis, a condition that makes bones fragile and brittle^[1]. In some cases, the bone can be so weak that it breaks spontaneously while someone is just walking or standing, and doctors say the break happens before the fall^[1].

The goal of hip fracture treatment is not just to mend the broken bone, but to get patients back on their feet as quickly and safely as possible, prevent life-threatening complications, preserve mobility, and restore quality of life. Treatment approaches depend on the type and location of the fracture, the patient’s age, overall health, and how active they were before the injury. There are well-established surgical methods recommended by medical societies and ongoing research exploring better ways to care for patients after these serious injuries^[2].

Understanding Where the Hip Breaks

The hip is a ball-and-socket joint where the rounded top of the femur (the thighbone) fits into a cup-shaped socket in the pelvis. When doctors talk about a hip fracture, they mean a break in the upper part of the femur near the hip joint. The location of the break determines the treatment approach^[1].

There are several common areas where the femur can fracture. The femoral neck is the narrow section of bone just below the ball-shaped head of the femur. This is the most common site for hip fractures, especially in older adults. The intertrochanteric region is located slightly lower, in the area between two bony bumps called the greater and lesser trochanters, where muscles and tendons attach. Fractures can also happen below these landmarks in the subtrochanteric area, which is the upper part of the long shaft of the femur. Femoral head fractures, where the rounded ball itself breaks, are extremely rare and usually result from severe trauma^[1][2].

The pattern of the break also matters. Doctors classify fractures based on their shape and direction: transverse fractures run straight across the bone, oblique fractures angle across, spiral fractures twist around the bone, and comminuted fractures involve the bone shattering into multiple pieces^[4].

Standard Surgical Treatment

Almost everyone who breaks a hip needs surgery to repair the fracture^[4]. The type of surgery depends on where and how severely the bone broke, whether the broken pieces are properly aligned, and the patient’s age and underlying health conditions^[2]. Surgery should ideally happen within 24 to 48 hours after the fracture occurs, unless doctors need time to stabilize other medical conditions first^[12][15]. Operating quickly optimizes outcomes and reduces the risk of complications.

One common surgical approach is internal repair using screws. Metal screws are inserted into the bone to hold the broken pieces together while the fracture heals. Sometimes these screws are attached to a metal plate that runs along the thighbone for additional stability^[2]. This method works well for certain types of fractures, particularly in younger patients or when the bone quality is good.

Another option is total hip replacement, where the upper part of the femur and the socket in the pelvic bone are both replaced with artificial parts called prostheses. Studies increasingly show that total hip replacement can be more cost-effective and lead to better long-term outcomes for certain patients, particularly older adults with displaced femoral neck fractures^[2]. A partial hip replacement, called hemiarthroplasty, replaces only the femoral head with an artificial component, leaving the socket intact. This is sometimes chosen for older patients with limited life expectancy or certain types of fractures^[6][17].

Some patients may require external fixation, where pins or screws are inserted into the bone and connected to an external frame to stabilize the fracture^[7]. However, this is less common than internal methods.

For patients who are not healthy enough for surgery due to significant medical problems or very short life expectancy, traction might be used. Skeletal traction involves inserting screws, pins, and wires into the femur under local anesthesia and setting up a pulley system with heavy weights to help align the bones while the injury heals. However, this non-operative approach is rarely chosen because surgery offers so many advantages^[7][11].

Essential Medications During Treatment

Patients receive several important medications before, during, and after hip fracture surgery. Prophylactic antibiotics are given before surgery to prevent infection. These antibiotics, particularly those effective against the bacterium Staphylococcus aureus, significantly reduce the risk of surgical site infections^[15].

To prevent dangerous blood clots that can form after surgery, patients receive thromboembolic prophylaxis. Low-molecular-weight heparin is the preferred medication for preventing deep vein thrombosis (blood clots in the leg veins) and pulmonary embolism (blood clots that travel to the lungs). This medication is typically continued for about 28 days after surgery, though some patients may need it longer depending on their individual risk factors^[15][17].

Pain management is a critical component of recovery. Patients receive various pain medications both during their hospital stay and after discharge. Controlling pain effectively allows patients to participate in physical therapy and early mobilization, which are essential for recovery^[8][17]. The pain usually lessens over several weeks as the bone heals and strength improves.

Recovery and Rehabilitation

Rehabilitation is absolutely critical to long-term recovery after a hip fracture^[15]. Physical therapy typically begins on the first day after surgery. Despite having just undergone an operation, patients are encouraged to get out of bed and start moving as soon as possible. This early mobilization helps prevent complications like pneumonia, pressure sores, and muscle wasting^[1].

Most patients stay in the hospital for about one to four weeks, depending on their progress and the complexity of their surgery^[14][18]. After leaving the hospital, many patients need additional rehabilitation. Some can continue physical therapy at home, but many require a stay in a rehabilitation center or skilled nursing facility for several weeks^[8].

The rehabilitation process focuses on restoring functional capability. Physical therapists guide patients through exercises that strengthen muscles, improve balance, restore range of motion, and help them relearn everyday activities like getting in and out of bed, using the toilet, bathing, and dressing. Patients often use walking aids such as walkers or crutches for at least six weeks after surgery, and some may need them longer^[17]. The healthcare team will let patients know when it’s safe to stop using these aids and when they can resume activities like driving, which is usually not allowed for at least two to three months after surgery^[17].

It usually takes several weeks to months to recover from a hip fracture, though recovery time varies greatly between individuals. Only about half of patients who survive a hip fracture regain their ability to walk independently, and approximately 20% end up needing to move to a long-term care facility^[15]. About 50% of patients recover their ability to perform basic daily activities like they did before the fracture, but only 25% fully recover their ability to do more complex tasks^[15]. Some patients may never regain the same strength and movement they had before breaking their hip^[14].

Preventing Another Fracture

After someone has had one hip fracture, preventing a second fracture becomes a major priority. Most patients should be treated with bisphosphonate medications, which help strengthen bones and reduce the risk of future fractures. These medications are typically recommended regardless of bone mineral density measurements, unless there are specific reasons a patient cannot take them^[15]. Doctors should also check patients for osteoporosis and discuss starting or continuing treatment with bone-strengthening medicines^[8][17].

Many patients benefit from a formal fall-prevention assessment^[15]. This evaluation looks at factors that increase fall risk, such as vision problems, balance difficulties, medication side effects, and home hazards. Healthcare teams may recommend changes to the home environment, such as removing loose rugs, improving lighting, installing grab bars in bathrooms, and rearranging furniture to create clear walking paths^[17][21].

In some regions, a fracture liaison service can help patients over 50 who have broken their hip. These services coordinate care to prevent further broken bones and keep bones healthy through proper screening, treatment, and follow-up^[14].

Special Considerations and Movement Precautions

Depending on the type of surgery performed, patients may need to follow specific movement precautions to protect the healing bone and prevent dislocation. If a patient had a hemiarthroplasty (partial hip replacement), they typically need to follow hip precautions for three months. These precautions include avoiding bending the hip more than 90 degrees, not crossing the legs, and using special equipment like elevated toilet seats and abductor pillows to keep the legs separated while lying down^[16][17].

If the hip was repaired using nails or screws without joint replacement, movement precautions may not be necessary, but weight-bearing restrictions often apply. Patients must follow their surgeon’s specific instructions about how much weight they can put on the affected leg and for how long^[17].

Patients should also be careful about activities that might increase the risk of blood clots. Long-distance travel is not recommended in the first three months after surgery because sitting for extended periods increases clot risk. Anyone planning to travel should discuss this with their healthcare team^[17].

Long-Term Outlook and Complications

Hip fractures carry serious risks. Between 12% and 17% of patients die within the first year after a hip fracture, and the long-term risk of death remains twice as high as people who haven’t had a fracture^[3][15]. The annual cost of hip fracture care in the United States exceeds $17 billion, with individual patients spending an estimated $40,000 in the first year following their fracture^[3].

Complications can include infection at the surgical site, blood clots in the legs or lungs, pneumonia, pressure sores, and problems with the surgical repair such as hardware failure or improper healing. Femoral neck fractures carry an additional risk: because the break can interrupt blood supply to the femoral head, patients may develop avascular necrosis, where bone tissue dies due to lack of blood flow. This complication is less common with intertrochanteric fractures^[6][16].

Promising Research and Future Directions

While the provided sources focus primarily on standard surgical and medical treatment for hip fractures, they do not include detailed information about specific experimental therapies or drugs currently being tested in clinical trials for hip fracture treatment. The focus of ongoing research in hip fracture care tends to be on optimizing surgical techniques, improving rehabilitation protocols, developing better fracture prevention strategies, and finding more effective ways to treat osteoporosis to prevent future fractures. Clinical trials in this field often compare different surgical approaches, timing of surgery, pain management strategies, and rehabilitation methods to determine which approaches lead to the best outcomes for patients.

Most common treatment methods

• Surgical repair with internal fixation
  • Metal screws are inserted into the bone to hold broken pieces together while healing occurs
  • Screws may be attached to a metal plate running along the thighbone for added stability
  • Commonly used for certain fracture types, particularly in younger patients
• Total hip replacement
  • Both the upper femur and the socket in the pelvic bone are replaced with artificial parts
  • Increasingly shown to be cost-effective and produce better long-term outcomes for certain patients
  • Often recommended for older adults with displaced femoral neck fractures
• Partial hip replacement (Hemiarthroplasty)
  • Only the femoral head is replaced with an artificial component
  • The socket remains intact
  • Sometimes chosen for older patients with limited life expectancy
  • Requires following hip movement precautions for three months after surgery
• Pain management medications
  • Various pain medications given during hospital stay and after discharge
  • Effective pain control allows participation in physical therapy and early mobilization
  • Pain typically lessens over several weeks as bone heals
• Blood clot prevention therapy
  • Low-molecular-weight heparin is the preferred medication
  • Prevents deep vein thrombosis and pulmonary embolism
  • Typically continued for 28 days after surgery
• Infection prevention with antibiotics
  • Prophylactic antibiotics given before surgery
  • Particularly effective against Staphylococcus aureus
  • Significantly reduces risk of surgical site infections
• Physical therapy and rehabilitation
  • Begins on the first day after surgery
  • Focuses on strengthening muscles, improving balance, and restoring mobility
  • May continue at home or in a rehabilitation facility for several weeks
  • Critical for long-term recovery and regaining independence
• Bisphosphonate medications for bone strengthening
  • Help prevent future fractures by strengthening bones
  • Recommended for most patients after hip fracture
  • Given regardless of bone mineral density measurements unless contraindicated