How to Treat a Hip Fracture

Hip fractures can occur in the neck of the femur (thigh bone), which is about 1 to 2 inches from the joint, or in the trochanter, the protrusion of the femur located about 3 to 4 inches from the joint.

How are hip fractures treated?

The American Academy of Orthopaedic Surgeons recently issued guidelines on the best surgical approaches for patients age 60 and up. The guidelines call for different treatments depending on a patient’s individual circumstances, including the location of the fracture, whether the break is stable or displaced, overall bone and joint health, and activity level.

A panel of physicians and physical therapists from leading academic medical centers, as well as participants from orthopedic and other medical societies, reviewed evidence from peer-reviewed studies. They created 30 different patient scenarios and rated different treatment approaches “appropriate,” “may be appropriate,” or “rarely appropriate.”

For example, total hip replacement is rated “appropriate” for a highly active elderly patient with a stable fracture in the neck of the femur, but “rarely appropriate” for a patient who is not able to walk.

The panel also issued guidelines for hip fracture recovery, recommending rehabilitation and care for all elderly patients to treat deep vein thrombosis, delirium, and pain, and to assess for osteoporosis.

The guidelines include a list of steps patients can take to help prevent future falls, such as participating in a fall prevention program, and increasing bone density with supplements and medications.

What are the possible complications?

Some complications of hip fractures include infection, deep vein thrombosis (blood clotting in the deep veins of the leg), pulmonary embolism (a blood clot that travels to the lung), pneumonia and pressure ulcers (breaks in the skin that can become infected).

Many of these complications result from bed rest and inactivity after surgery. Medications for pain control can lead to disorientation and confusion. Complications can become more serious in people who are older or have other health problems.

Is rehabilitation necessary?

Rehabilitation after hip fracture is essential for regaining the ability to walk and live independently.

Most individuals who were able to live independently before the hip fracture will require home care and assistance. About half will require canes or walkers for several months after surgery, and nearly half of this group will need a cane or walker to move around the house or outdoors for the rest of their lives.

Read more about hip-fracture prevention, including how to prevent osteoporosis and weighing the pros and cons of osteoporosis drugs.