A hip fracture is a break in the upper end of the thigh bone (femur) near the hip joint; in older people it usually follows a simple fall from standing height on weakened bone [1][2]. Treatment is almost always surgery, and guidelines recommend operating on the day of, or the day after, admission and getting the patient out of bed the day after surgery [3]. Recovery takes weeks to months, and physiotherapy, fall prevention and a bone health check are part of care [1][3].
What is a hip fracture?
A hip fracture is a break in the upper part of the thigh bone close to the hip joint. Depending on the site there are femoral neck, intertrochanteric and subtrochanteric fractures; femoral neck and intertrochanteric fractures are the most common [2].
In older people most hip fractures result from simple falls from standing height onto weakened bone [2]. Hip fractures are more common in older people and in those with osteoporosis [1].
Which signs after a fall suggest a hip fracture?
After a fall, these suggest a hip fracture [1][2]:
- Pain in the hip, groin or upper thigh
- Being unable to stand up or put weight on the leg
- Difficulty moving the hip and leg
- The leg looking shorter than the other or turned outwards
- Swelling and bruising around the hip
What leads to falls?
The main cause is a fall, and older age and osteoporosis clearly raise the risk [1][2]. In some fractures where the bone has not moved, pain may be mild at first and the person may still walk for a while, so groin pain that does not settle after a fall should be taken seriously [2].
Things that raise the risk of falling include reduced balance and muscle strength, eyesight and hearing problems, medicines that can affect balance, poorly fitting footwear and trip hazards at home [6].
Diagnosis
A hip fracture is usually confirmed with an X-ray, which also helps decide on treatment [1][2]. A CT scan can add detail for planning surgery [2].
If symptoms point to a fracture but the X-ray looks normal, an MRI scan is recommended; if MRI cannot be done within 24 hours, a CT scan is considered [3].
Why surgery?
Surgery is the standard treatment for a hip fracture in older people [1]. Long bed rest can lead to serious problems such as blood clots, pneumonia, pressure sores and confusion; surgery aims to reduce these risks by getting the patient moving early [2]. Patients managed without surgery have been found to have a higher risk of death, so non-surgical treatment is considered only in selected situations [5].
How soon should the operation be?
Guidelines recommend surgery on the day of, or the day after, admission. Correctable problems such as anaemia, blood thinners, fluid and salt imbalance or uncontrolled diabetes are dealt with straight away so that surgery is not delayed [3]. In a large systematic review, surgery within 48 hours was linked with better mobility, fewer complications, shorter hospital stays and lower death rates, with further benefits reported for surgery within 24 hours [4].
Types of operation and care around surgery
Good pain control matters; if medicines are not enough, trained staff can give nerve blocks, but these should not delay surgery [3]. Guidelines recommend a multidisciplinary hip fracture programme in which orthopaedic surgeons and older-person specialists work together, and an operation that allows the patient to put full weight on the leg straight away [3].
The type of operation depends on the fracture pattern and the person's condition [1][3]:
- Displaced femoral neck fractures: partial (hemiarthroplasty) or total hip replacement
- Undisplaced femoral neck fractures: fixation with screws or a plate and screws
- Intertrochanteric fractures: a sliding hip screw or an intramedullary nail
- Subtrochanteric fractures: an intramedullary nail
Recovery and rehabilitation
A physiotherapy assessment and getting out of bed start the day after surgery unless there is a medical reason not to, and continue every day [3]. The hospital stay is usually between one and four weeks, and exercises to continue at home are given on discharge [1].
Early movement helps prevent the complications of being bed-bound and helps people keep their independence. Some patients continue rehabilitation in a care or rehabilitation facility, others have physiotherapy at home [2]. Recovery takes weeks to months, and some people may not fully regain their previous strength [1].
After a hip fracture, bone health and fall risk should be assessed and the person referred to services that help prevent further fractures [1][3]. To prevent new falls: remove trip hazards at home, fit grab rails in the bathroom, wear well-fitting shoes with good grip, have regular eye tests, ask whether any medicines affect balance, and do strength and balance exercises at least twice a week [6].
When not to wait: call for emergency help
If an older person cannot get up after a fall because of pain in the hip, groin or thigh, cannot put weight on the leg, or the leg looks short and turned outwards, call for emergency help straight away [1][2]. Even if pain is mild, difficulty walking that continues after a fall needs assessment, because undisplaced fractures can be missed at first [2][3].
Frequently asked questions
- Can a hip fracture heal without surgery?
- Surgery is the standard treatment for hip fracture in older people [1]. Patients managed without surgery have a higher risk of death, so this option is considered only in carefully selected situations [5].
- How soon should surgery be done?
- Guidelines recommend surgery on the day of, or the day after, admission [3]. Surgery within 48 hours is linked with fewer complications and lower death rates [4].
- When can you walk after surgery?
- Unless there is a medical reason not to, patients are helped out of bed by a physiotherapist the day after surgery, and the operation is planned so that full weight can be put on the leg straight away where possible [3].
- How long does recovery take?
- The hospital stay is usually one to four weeks and overall recovery takes weeks to months. Some people do not fully regain their previous strength [1].
At our clinic we go through the operation options and the recovery that follows with the patient and their family.
Sources
- Broken hip. NHS (nhs.uk), 2026. nhs.uk
- Hip Fractures. American Academy of Orthopaedic Surgeons (OrthoInfo). orthoinfo.org
- Hip fracture: management (CG124). National Institute for Health and Care Excellence (NICE), 2023. nice.org.uk
- What is the association between time to surgery and patient outcome after hip fracture? A systematic review. The Bone & Joint Journal (Mazarello Paes V, et al.), 2026. pubmed.ncbi.nlm.nih.gov
- Epidemiology, patient outcome and complications after non-operative management of hip fracture: a systematic review. Anaesthesia (Winfield J, et al.), 2025. pubmed.ncbi.nlm.nih.gov
- Falls. NHS (nhs.uk), 2025. nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.