Broken hip - Treating a hip fracture

Hip fractures are usually treated in hospital with surgery.

Most people will need surgery to fix the fracture or replace all or part of their hip, ideally on the day they're admitted to hospital or the day after.

There are a number of different operations which are described below. The type of surgery you have will depend on:

• the type of fracture you have (where in the femur the fracture is)
• your age
• how physically mobile you were before the hip fracture
• your mental ability to take part in the post-surgery rehabilitation programme
• the condition of the bone and joint – for example, if you have arthritis (pain and inflammation of a joint)

Internal fixation

Internal fixation means fixing the fracture (break in the bone) using devices to hold the bone in place while it heals. These include:

• pins
• screws
• rods
• plates

Internal fixation tends to be used for fractures outside the socket of the hip joint (extracapsular), or fractures inside the socket of the hip joint (intracapsular) which are stable and haven't moved significantly (undisplaced).

If internal fixation is used for an intracapsular fracture, you'll need follow up appointments over several months with X-rays to check you're healing.

Hemiarthroplasty

Hemiarthroplasty means replacing the femoral head with a prosthesis (false part). The femoral head is the rounded top part of the femur (upper thigh bone) that sits in the hip socket.

The procedure is often the preferred option for fractures inside the socket of the hip joint (intracapsular), which occur in people who already have reduced mobility prior to the fracture. 

Complete hip replacement

A complete hip replacement is an operation to replace both the natural socket in the hip and the femoral head with prostheses (false parts).

This is a more major operation than hemiarthroplasty and isn't necessary in most patients but may be considered if you already have a condition that affects your joints, such as arthritis, or you're very active.

Read more about hip replacement.

Pre-operative assessment

Providing you're in a stable condition, you'll ideally have surgery within 36 hours of arriving at hospital.

You'll have a pre-operative assessment to check your overall health and make sure you're ready for surgery.

During your assessment you'll be asked about any medications you're currently taking, and any necessary tests and investigations will be carried out.

You'll also have an anaesthetic assessment to decide what type of anaesthesia to use. Different types include:

• spinal or epidural anaesthesia that's used to numb the nerves in the lower half of your body so you can't feel anything in this area
• general anaesthetic which makes you unconscious and prevents your brain recognising any signals from your nerves, so you can't feel anything

Before surgery

Hip fractures can be very painful. During diagnosis and treatment, you should be given medication to relieve your pain. Initially, pain relief is usually given intravenously (through a needle into a vein in your arm), with a local anaesthetic injection near the hip.

Before your operation you'll be given antibiotics. This is to reduce the risk of your wound becoming infected after surgery.

Surgery carries the risk of a blood clot forming in a vein, so steps will be taken to reduce this risk. For example, you may have injections of medication, such as heparin, which is an anticoagulant that reduces the blood's ability to clot.

You'll continue to be monitored for venous thromboembolism (VTE, blood clot in a vein) during your stay in hospital. You may still need medication after you're discharged. 

Your operation

Depending on which type of surgery you're having (see above), the operation will last around two hours.

If you have any questions about your operation, ask your surgeon or another member of your care team.

After the operation, you'll begin your rehabilitation programme. This may take place in a different ward to the one where you had surgery.

Read more about recovering from hip fracture surgery.

Conservative treatment

Conservative treatment is the alternative to surgery. It involves a long period of bed rest and isn't often used because it can:

• make people more unwell in the long-term
• involve a longer stay in hospital
• slow down recovery

However, conservative treatment may be necessary if surgery isn't possible – for example, if someone is too fragile to cope with surgery, or if the fracture occurred a few weeks earlier and has already started to heal.