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Health condition · Clinically reviewed

Hip fracture, urgent surgery, orthogeriatric care and protecting the next bone.

A hip fracture is a serious event, but a modern UK pathway - surgery within 36 hours, joint orthogeriatric care and a clear rehabilitation plan - changes outcomes.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG124, the British Orthopaedic Association (BOA) and the British Geriatrics Society Blue Book.

  • 03

    Current for 2026

    Reflects modern UK orthogeriatric practice, the National Hip Fracture Database and updated bone-protection options.

Key facts

Hip fracture at a glance.

The essentials, in plain English - what it is, the two main types, and how modern UK care shapes recovery.

  • What it is

    A proximal femoral fracture, almost always after a fall in an older adult with weakened bone.

  • How common

    Around 70,000 hip fractures happen in the UK every year, most in women over 75 with osteoporosis.

  • Two main types

    Intracapsular (subcapital, transcervical, basicervical) and extracapsular (intertrochanteric, subtrochanteric).

  • Time to surgery

    NICE recommends surgery within 36 hours of admission for the great majority of patients.

  • Orthogeriatric care

    Joint orthopaedic and geriatric medicine input is the single biggest driver of good outcomes.

  • Mortality

    About one in fourteen patients die within 30 days and roughly one in three within a year - most from underlying frailty.

Why this guide matters

A pathway, not a procedure.

A hip fracture is a whole-body event in a frail patient - the three points below shape everything else on this page.

  • Time to surgery is the outcome

    Operating within 36 hours cuts pain, delirium, pressure ulcers and mortality across almost every subgroup.

  • Orthogeriatrics is the standard

    Joint orthopaedic and geriatric care from admission is the single biggest driver of a good recovery.

  • The next fracture is preventable

    A DEXA scan, falls assessment and modern bone-protection plan turn one hip fracture into the last one.

How the diagnosis is made

From the fall to a clear surgical plan.

The steps a UK emergency department and orthopaedic team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and mechanism

    A structured account of the fall, previous fractures, medications, alcohol and social circumstances.

  2. 02

    Assessing

    Focused examination

    The classic shortened, externally rotated leg - plus a full neurovascular check of the limb and a look for other injuries.

  3. 03

    Assessing

    X-ray of the pelvis and hip

    AP pelvis and a true lateral of the affected hip, with a full-length femur view if a shaft injury is suspected.

  4. 04

    Confirming

    MRI for occult fracture

    If X-rays are normal but suspicion is high - especially in a patient who cannot weight-bear - MRI is the next step.

  5. 05

    Confirming

    Preoperative workup

    FBC, U&Es, LFTs, coagulation, group and save or crossmatch, ECG and a chest X-ray where indicated.

  6. 06

    Preparing

    Medical optimisation

    Orthogeriatric review corrects anaemia, hydration, delirium risk and anticoagulation before theatre.

  7. 07

    Preparing

    Surgical planning

    Fracture pattern, patient fitness and pre-injury mobility guide the choice between fixation and replacement.

Typical timeline: from the ambulance door to theatre within 36 hours.

Symptoms

What a hip fracture actually looks like.

The classic picture is a fall, hip pain and an inability to weight-bear - but a minority hide behind an occult, undisplaced pattern.

  • Sudden hip or groin pain

    Almost always after a fall - occasionally after a twist in someone with very weak bone.

  • Inability to weight-bear

    Most patients cannot stand or take a step - a strong signal even when X-rays look normal.

  • Shortened, externally rotated leg

    The classic look in a displaced fracture - the foot points outwards and the leg looks shorter.

  • Referred pain to the knee

    Hip-fracture pain often travels down the thigh to the knee - easy to miss without an X-ray.

  • Bruising and swelling

    Extracapsular fractures often show a large bruise around the outer hip within a day or two.

  • Occult undisplaced fracture

    A minority can still weight-bear a little - suspicion should stay high and MRI is often needed.

  • Stress fracture pattern

    In runners, military recruits and women with amenorrhoea - insidious groin pain worsened by loading.

  • Red flag - hip pain after a fall

    Any older adult with hip, groin or knee pain after a fall needs urgent hospital assessment.

Treatment

How hip fracture is treated in the UK.

Prompt regional analgesia, surgery within 36 hours, an implant matched to the fracture pattern - and rehabilitation from day one.

  • Early surgery within 36 hours

    The single most important intervention - reduces pain, complications and mortality across almost every subgroup.

  • Fascia iliaca block and multimodal analgesia

    A regional block on arrival plus paracetamol and cautious opioids - opioids alone are rarely enough.

  • Cemented hemiarthroplasty

    The default for displaced intracapsular fractures in less mobile patients - a modern cemented stem with a bipolar head.

  • Total hip replacement

    For fitter, independently mobile patients with a displaced intracapsular fracture - better long-term function than a hemiarthroplasty.

  • Cannulated hip screws

    For undisplaced intracapsular fractures, particularly in younger patients where the femoral head is worth preserving.

  • Dynamic hip screw (DHS)

    The workhorse for stable intertrochanteric extracapsular fractures - reliable, cheap and well understood.

  • Intramedullary nail

    For unstable intertrochanteric, reverse-oblique and subtrochanteric fractures - a load-sharing implant down the femoral canal.

  • Orthogeriatric comanagement

    Daily joint input from orthopaedics and geriatric medicine - the biggest single driver of good outcomes after hip fracture.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and the National Hip Fracture Database, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your orthopaedic and orthogeriatric team know your history and imaging, and can tell you which parts apply to you. If in doubt, ask.

  • NICE. Hip fracture: management (CG124).

  • British Orthopaedic Association. BOAST - The Care of the Older or Frail Orthopaedic Trauma Patient.

  • British Geriatrics Society. The Blue Book on the care of patients with fragility fracture.

  • National Hip Fracture Database (NHFD). Annual reports and standards.

  • Royal Osteoporosis Society. Clinical guidance for fracture prevention and bone-protection medicines.

Red flags

When a hip fracture needs urgent attention.

The scenarios that shift a routine pathway into a specialist emergency - and where senior input should not wait.

  • Hip pain and inability to weight-bear

    After any fall in an older adult, treat as a hip fracture until proven otherwise - urgent hospital assessment and imaging.

  • Normal X-ray but persistent pain

    Occult and undisplaced fractures are missed on plain films - MRI within 24 hours is the standard of care.

  • Open fracture or vascular injury

    A rare but limb-threatening emergency needing immediate orthopaedic and vascular input.

  • Delirium on admission

    Common, under-recognised and worsens outcomes - a routine part of orthogeriatric review, not an afterthought.

  • Anticoagulation on arrival

    DOACs, warfarin and antiplatelets change the surgical timeline - handled by a clear local pathway, not delayed indefinitely.

  • A second low-trauma fracture

    A fragility fracture on a background of another is a defining osteoporosis diagnosis and mandates bone protection.

  • Pathological fracture

    A fracture through abnormal bone - always consider metastatic disease, myeloma or a primary bone lesion.

  • Pressure damage on the heel

    Pressure-ulcer prevention begins on arrival - a preventable harm that ruins recovery when it happens.

  • Postoperative chest pain or breathlessness

    Pulmonary embolism, myocardial infarction and pneumonia are the classic postoperative killers - low threshold to investigate.

Living with it

Recovery is a plan, not a wait.

Four things that make the biggest difference in the year after a hip fracture - early movement, bone protection, falls prevention and structured rehabilitation.

A quiet reminder

The next fracture is the one to prevent.

A DEXA scan, vitamin D and calcium where needed, and a modern bone-protection medicine turn a first hip fracture into the last.

  1. 01 Move

    Get up on day one

    Early mobilisation with a physiotherapist the day after surgery is a proven driver of recovery - not a luxury.

  2. 02 Protect

    Treat the underlying bone

    A hip fracture is almost always a fragility fracture - a DEXA scan and bone-protection plan are non-negotiable.

  3. 03 Prevent

    Falls assessment matters

    Medication review, vision check, home hazards and strength and balance work all cut the risk of the next fall.

  4. 04 Rehab

    Rehabilitation is long

    Full recovery of confidence and function takes months, not weeks - and works best with a clear MDT plan.

Frequently asked

Everything we get asked about hip fracture.

Quick answers on surgery, implants, orthogeriatric care, bone protection and recovery.

  • What is a hip fracture?

    A break of the top part of the femur (thigh bone), usually within a few centimetres of the hip joint. Most happen after a fall in an older adult with weakened bone. They are classified as intracapsular - inside the joint capsule (subcapital, transcervical, basicervical) - or extracapsular, outside it (intertrochanteric, subtrochanteric).

  • Why does surgery need to happen so quickly?

    NICE recommends surgery within 36 hours of admission for almost all patients. Early surgery cuts pain, reduces pressure ulcers, delirium and pneumonia, shortens hospital stay and lowers mortality. Only reversible medical problems (severe anaemia, uncontrolled heart failure, correctable coagulopathy) should delay theatre.

  • What is the difference between a hemiarthroplasty and a total hip replacement?

    Both replace the femoral head. A hemiarthroplasty replaces only the head and is the standard choice for older, less mobile patients with a displaced intracapsular fracture. A total hip replacement also resurfaces the socket and gives better long-term function in fitter, independently mobile patients who were pain-free before the fall.

  • What is orthogeriatric care and why does it matter?

    It is a shared model where an orthopaedic team and a geriatric medicine team look after the patient together from admission to discharge. It reduces mortality, delirium and length of stay and is the single biggest driver of good outcomes in modern hip-fracture care.

  • How is the bone protected after a hip fracture?

    Almost every hip fracture is a fragility fracture, so a bone-protection plan is essential. It usually starts with vitamin D and calcium if needed, and adds a bisphosphonate (oral or intravenous), denosumab, or - for very high-risk patients - romosozumab, guided by a DEXA scan and specialist osteoporosis input.

  • What does recovery look like in the first year?

    The first six weeks are focused on wound healing, weight-bearing and confidence. Most patients regain independent transfers within days and walk with an aid within weeks. Full recovery of strength and balance takes six to twelve months and depends heavily on rehabilitation, falls prevention and bone protection.

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