Hip Fractures and Their Management

A hip fracture is a serious injury that significantly affects mobility and independence, particularly in older adults. Managing a hip fracture involves timely diagnosis, appropriate surgical or non-surgical treatment, and a structured rehabilitation programme. This article outlines key aspects of hip fracture management, from emergency care to long-term recovery strategies.

Immediate Management of a Hip Fracture

Early intervention is necessary to reduce complications and support recovery.

Emergency Stabilisation

A suspected hip fracture requires urgent medical attention. Patients should avoid putting weight on the affected leg and seek immediate transportation to a hospital. Pain relief is provided as soon as possible, often through intravenous medications.

Diagnostic Imaging

X-rays are the standard method for confirming a hip fracture. If the fracture is not visible but still suspected, an MRI or CT scan may be performed to detect hidden breaks.

Pre-Surgical Assessment

Before surgery, a medical evaluation is performed to identify any underlying conditions that could affect anaesthesia or recovery. This includes blood tests, an ECG, and chest X-rays to assess overall health and detect potential risks.

Surgical Management of Hip Fractures

Surgery is the primary treatment for most hip fractures, aiming to restore stability and mobility. The type of procedure depends on the fracture type and the patient’s overall health.

Internal Fixation (Hip Pinning)

This procedure involves the use of metal screws, plates, or rods to stabilise the fractured bone while it heals. It is mainly used for femoral neck and intertrochanteric fractures, particularly in younger patients or those with minimal bone displacement. Internal fixation allows the bone to heal in its natural position while maintaining joint integrity. However, if healing is compromised due to poor blood supply, further surgery may be required.

Partial Hip Replacement (Hemiarthroplasty)

Hemiarthroplasty is performed when the femoral head is severely damaged or when blood supply to the area is insufficient for healing. In this procedure, the damaged femoral head is replaced with a prosthetic implant while preserving the natural hip socket. It is typically recommended for older adults who have lower activity levels but still require good joint function for daily movement.

Total Hip Replacement (THR)

Total hip replacement involves replacing both the femoral head and the hip socket with artificial components. This procedure is considered for patients with pre-existing arthritis, severe joint damage, or high activity levels. Compared to hemiarthroplasty, THR generally provides better long-term mobility and function. It is particularly beneficial for patients who wish to maintain an active lifestyle after surgery.

Intramedullary Nailing

Intramedullary nailing is commonly used for intertrochanteric and subtrochanteric fractures. A long metal rod (intramedullary nail) is inserted into the femur to provide internal support and stability. This technique allows for early weight-bearing and helps maintain bone alignment during the healing process. It is often preferred for patients with complex fractures requiring additional reinforcement.

Non-Surgical Management

While surgery is the preferred treatment, some cases may require a non-operative approach.

Conservative Treatment

Conservative management is reserved for patients who are unable to undergo surgery due to severe medical conditions. It involves strict bed rest, pain management, and gradual rehabilitation. However, prolonged immobility increases the risk of complications such as deep vein thrombosis, pressure sores, and muscle loss. As a result, conservative treatment is only considered when surgical options are not feasible.

Traction and Bracing

Traction and bracing may be used in select cases where surgical intervention is not possible. This method helps maintain bone alignment and reduces pain by applying controlled force to the leg. However, traction is rarely a first-line treatment as it requires extended bed rest, which can lead to further complications.

Post-Surgical Recovery and Rehabilitation

A structured rehabilitation programme is necessary for regaining mobility and reducing the risk of complications after surgery.

Early Mobilisation

Movement is encouraged within 24 to 48 hours after surgery to prevent complications such as blood clots and muscle deconditioning. The extent of weight-bearing depends on the type of surgery performed. Patients are initially assisted with walking aids such as crutches or a walker before gradually increasing their mobility.

Pain Management

Effective pain control is necessary to support recovery and encourage movement. Pain relief typically includes a combination of oral painkillers, anti-inflammatory medications, and physiotherapy techniques. In some cases, nerve blocks or epidural injections are used to manage post-operative discomfort in the early recovery phase.

Physical Therapy

Physiotherapy helps in restoring strength, balance, and coordination. Initial exercises focus on gentle range-of-motion movements, followed by progressive strengthening activities. Gait training helps patients regain confidence in walking while minimising the risk of falls. Rehabilitation is adjusted based on individual recovery progress.

Nutritional Support

Proper nutrition supports bone healing and overall recovery. A diet rich in calcium, vitamin D, and protein is recommended to enhance bone strength and muscle function. In some cases, supplements may be prescribed to address deficiencies and improve healing. Adequate hydration and balanced meals also reduce the risk of post-operative complications.

Preventing Secondary Fractures

Preventing future fractures is a key part of long-term recovery. Osteoporosis treatment, including medications such as bisphosphonates, may be prescribed to strengthen bones and reduce fracture risk. Patients are also advised to engage in weight-bearing exercises and lifestyle modifications to maintain bone health and prevent further injuries.

Long-Term Management and Rehabilitation

A structured long-term approach, including physiotherapy and bone health monitoring, helps restore function, maintain mobility, and prevent future fractures.

Outpatient Physiotherapy

After discharge from the hospital, continued physiotherapy is necessary to regain full function. Outpatient sessions focus on improving flexibility, muscle strength, and endurance. Low-impact activities such as swimming may be introduced to support joint recovery without excessive strain.

Bone Health Monitoring

Regular bone density scans (DEXA) help assess osteoporosis and fracture risk, particularly in older adults. Ongoing evaluation allows for adjustments in treatment plans, including medication management and lifestyle changes to maintain long-term bone strength. Preventive strategies, such as fall assessments and exercise programmes, further support bone health.

Conclusion

Hip fracture management involves immediate medical attention, surgical intervention, rehabilitation, and long-term care. Early mobilisation, physiotherapy, and bone health maintenance are key to a successful recovery. 

If you have experienced a hip fracture, schedule a consultation today for personalised management options.