A hip fracture is one of the most serious orthopaedic emergencies in adults, particularly in older patients where the consequences of delayed treatment can be swift and severe. Surgical intervention is almost always necessary and delay makes outcomes measurably worse. The window between fracture and treatment is not just a clinical consideration; it is where recovery trajectories are shaped. At CARE Hospitals, hip fractures are treated as the time sensitive emergencies with specialist orthopaedic teams involved from the moment of arrival.

What is a Hip Fracture?

The hip joint is a ball and socket joint in which the femoral head (the rounded top of the thigh bone) sits inside the pelvic socket. A hip fracture is a break in the proximal femur (upper thigh bone) not the pelvis itself. Hip fractures most commonly occur after falls in older adults or following high impact trauma such as road accidents in younger individuals. The following are the main types of hip fractures:

• Femoral neck fractures: Occur in the narrow bone just below the femoral head. Displacement of the fractured neck can cut the blood supply, causing avascular necrosis (bone death). 
• Intertrochanteric Fracture: Occurs between the two bony prominences of the upper femur. These fractures are outside the hip joint capsule and are less likely to compromise the blood supply.
• Subtrochanteric fractures: Occur further down the femur shaft, usually after high-energy trauma in younger patients.

Common Causes of Hip Fracture

Cause varies by age:

• Falls in older adults: A simple trip from standing height can result in a fracture of an osteoporotic (bone-thinned) hip
• Osteoporosis: Reduced bone density loss from age, hormonal changes, or corticosteroid (steroid tablet) use makes the hip more fragile and susceptible to fractures 
• Road traffic accidents: High-energy impact fractures the hip at any age, often with associated injuries
• Pathological fracture: Cancer, infection or Paget's disease (abnormal bone remodelling) weakens the hip so it breaks without significant force
• Stress fracture: Repeated loading without adequate recovery causes a fatigue crack through the femoral neck
• Falls in younger adults: From alcohol intoxication, seizures, or syncope (fainting).

Signs and Symptoms of Hip Fracture

Symptoms are usually clear after a fall, but undisplaced fractures are deceptive (the patient may bear weight and still have a fracture). Common signs and symptoms are:

• Severe hip, groin, or upper thigh pain that is worsened by any movement of the leg
• Inability to stand on the affected side although some undisplaced fractures allow limited weight-bearing
• The limb appears shorter and the foot points outward (the classic sign of a displaced hip fracture)
• Swelling and bruising (may take hours to appear)
• Groin tenderness 
• Deformity appears in high-energy fractures or pathological breaks; visible deformity of the hip region may be present.

First Aid for Hip Fracture (Before Reaching Hospital)

Correct first aid limits pain, prevents further injury and prepares for safe transfer:

• Call emergency services: A patient who cannot stand or bear weight needs an immediate ambulance assistance - attempting to lift or carry them without proper support risks displacing the fracture further and damaging the blood vessels and soft tissues surrounding it. 
• Immobilise the leg: Do not move the leg. Support the leg in the position it is in with rolled towels or folded clothing along both sides to prevent rotation. Do not straighten it.
• Apply ice if available: Wrap ice in a cloth and apply it to the hip for up to 20 minutes. Do not apply directly to the skin.
• Nothing by mouth: Surgery is likely. An empty stomach reduces anaesthetic risk. No food or drink from the time of injury.

When to Seek Emergency Care for Hip Fracture

A hip fracture after any fall in an adult particularly over 60, is always an emergency. Call emergency services when:

• Hip, groin, or thigh pain with inability to stand after a fall 
• Shortened, outwardly rotated leg after a fall 
• Hip pain after a fall in a patient with osteoporosis, steroid use, or cancer 
• Hip pain following a road accident or high-energy impact at any age
• Hip pain at rest or at night in a patient with known cancer (possible pathological fracture).

Emergency Treatment at the Hospital for Hip Fracture

Treatment follows a structured pathway:

• Assessment and pain control: Circulation, neurological status, and medical co-morbidities (other health conditions such as heart disease or blood thinners) are assessed. Doctors give an intravenous pain reliever,or a fascia iliaca block (a local anaesthetic injection that numbs the hip region).
• Imaging: Doctors perform plain X-rays in two views to confirm the fracture and its location. If X-ray is normal but clinical suspicion is high MRI is performed within 24 hours. CT is used for complex surgical planning.
• Medical optimisation: The medical team manages anticoagulants (blood thinners), blood pressure, blood sugar and cardiac risk before surgery. 
• Surgery: Femoral neck fractures in older patients are treated with hemiarthroplasty (replacing the femoral head with a metal prosthesis) or total hip replacement. Undisplaced neck and intertrochanteric fractures are treated with internal fixation like screws, sliding hip screws or an intramedullary nail (a rod down the femoral shaft). Surgery within 24 to 36 hours reduces complication rates.
• Post-operative care: Patients are stood at the bedside on the day of surgery. Low molecular weight blood thinners and compression stockings prevent deep vein thrombosis (blood clots in leg veins). Pressure mattresses and two-hourly repositioning prevent pressure sores.

What Not to Do

These actions worsen outcomes:

• Do not lift or carry a patient with a suspected hip fracture but wait for ambulance support
• Do not attempt to straighten or realign the fractured limb
• Do not give food or drink as surgery is likely and anaesthesia requires an empty stomach
• Do not delay calling emergency services
• Do not assume a walking patient has no fracture - some undisplaced fractures allow weight-bearing.

Conclusion

Hip fractures do not heal with rest and time. Surgery within 24 to 36 hours followed by immediate mobilisation and physiotherapy, separates full recovery from permanent loss of independence. At CARE Hospitals, emergency medicine, orthopaedic surgery, anaesthesia and geriatric medicine work together to move every eligible patient to theatre at the earliest safe opportunity.

FAQs

1. What should I do immediately after a hip fracture?

If you notice a hip fracture - call emergency services; keep still; do not lift; support the leg with rolled towels; cover with a blanket; give nothing to eat or drink.

2. How do I know if I have a hip fracture?

Severe hip or groin pain after a fall, inability to stand, and a shortened outwardly rotated leg are classic signs but X-ray or MRI is always required.

3. Can I walk with a fractured hip?

Some undisplaced fractures allow weight-bearing; walking does not exclude a hip fracture. Any hip pain after a fall needs imaging.

4. When is a hip fracture considered an emergency?

Always surgery within 24 to 36 hours reduces that risk and every hour of delay worsens the complication profile.

5. What causes hip fractures in older adults?

Osteoporosis (bone thinning) lowers the fracture threshold in older adults. Risk is increased by steroid tablets, low calcium and vitamin D and previous fragility fracture.

6. How are hip fractures diagnosed?

Investigations include:

• Plain X-rays in two views confirm most fractures.
• MRI when X-ray is normal but suspicion is high.
• CT for complex surgical planning.

7. Is surgery always required for a hip fracture?

In almost all cases, yes - non-operative management is reserved for patients not walking before injury, with very short life expectancy, or prohibitive anaesthetic risk.

8. Can hip fractures heal without surgery?

Theoretically, but bed rest carries a greater risk than surgery including pneumonia, blood clots, pressure sores, delirium, and muscle wasting giving conservative management a higher complication rate than surgery in older adults.

9. How long does rehabilitation after a hip fracture take?

Most patients stand on the day of surgery or shortly after and independent walking returns in four to twelve weeks. Full pre-fracture function is restored in three to six months in well-managed patients.

10. What precautions should be taken after hip fracture treatment?

Precautions are: 

• No hip flexion beyond 90 degrees, no leg crossing, no twisting for six to twelve weeks
• Daily physiotherapy
• Take calcium, vitamin D, and bisphosphonates (bone-strengthening tablets) to reduce re-fracture risk.

CARE Medical Team