Hip fracture

Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint. They're usually caused by a fall or an injury to the side of the hip, but may occasionally be caused by a condition, such as cancer, weakening the hip bone.

Falls are very common in older people, who may have reduced vision or mobility and balance problems.

Hip fractures are also more common in women, who are more susceptible to osteoporosis (weak and fragile bones).

Symptoms of a hip fracture 

Symptoms of a hip fracture after a fall may include:

• pain
• not being able to lift, move or rotate (turn) your leg
• being unable to stand or put weight on your leg
• bruising and swelling around the hip area
• a shorter leg on the injured side
• your leg turning outwards more on the injured side

A hip fracture won't necessarily cause bruising or prevent you from standing or walking.

When to seek medical help

If you think you've fractured your hip, you'll need to go to hospital as soon as possible. Dial 999 for an ambulance.

Try not to move while you're waiting for the ambulance and make sure you keep warm.

If you've fallen, you may feel shaken or shocked, but try not to panic. Try to get someone's attention by:

• calling out for help
• banging on the wall or the floor
• using your aid call button (if you have one)

Read more about what to do after a fall.

Hospital assessment

After arriving at hospital with a suspected hip fracture, your overall condition will be assessed. The doctor carrying out the assessment may:

• ask how you were injured and whether you had a fall
• ask if this is the first time you've fallen (if you did fall)
• ask about any other medical conditions you have
• ask whether you're taking any medication
• assess how much pain you're in
• assess your mental state (if you fell and hit your head, you may be confused)
• take your temperature 
• make sure you're not dehydrated

Depending on the outcome of your assessment, you may be given:

• painkilling medication
• a local anaesthetic injection near your hip
• intravenous fluid (fluid through a needle into a vein in your arm)

The healthcare professionals treating you will make sure you're warm and comfortable. After a while, you may be moved from the emergency department to a ward, such as an orthopaedic ward.

To confirm whether your hip has been fractured, you may require imaging tests such as:

• an X-ray 
• a magnetic resonance imaging (MRI) scan
• a computerised tomography (CT) scan

Treating a hip fracture

Surgery is usually the only treatment option for hip fractures.

The National Institute for Health and Care Excellence (NICE) recommends that someone with a hip fracture should have surgery within 48 hours of admission to hospital.

However, surgery may sometimes be delayed if the person is unwell with another condition and treatment would significantly improve the outcome of the operation.

In about half of all cases, a partial or complete hip replacement is needed. The other cases require surgery to fix the fracture with plates and screws or rods.

The type of surgery you need depends on a number of factors, including:

• type of fracture (where on the femur it is)
• your age
• your level of mobility before the fracture
• the condition of the bone and joint – for example, whether or not you have arthritis

Read more about treating a hip fracture.

Recovering from hip surgery

The aim after surgery is to speed up recovery to help regain your mobility.

The day after surgery, you should have a physiotherapy assessment and be given a rehabilitation programme that includes realistic goals for you to achieve during your recovery. The aim is to help you regain your mobility and independence so you can return home as soon as possible.

Read more about your care after discharge from hospital.

How long you'll need to stay in hospital will depend on your condition and mobility. It may be possible to be discharged in three to five days.

Evidence suggests that prompt surgery and a tailored rehabilitation programme that starts as soon as possible after surgery can significantly improve a person's life, reduce the length of their hospital stay and help them recover their mobility faster.

Read more about recovering from a hip fracture.

It may also be useful to read your guide to care and support – written not only for people with care and support needs, but their carers and relatives too. It includes information and advice on:

• transport and getting around with mobility issues
• rehabilitation or 'reablement' services
• choosing mobility equipment, wheelchairs and scooters

Complications of hip surgery

Complications can arise from surgery, including:

• infection – the risk is reduced by using antibiotics at the time of surgery and careful sterile techniques; infection occurs in about 1-3% of cases and requires further treatment and often further surgery
• blood clots – can form in the deep veins of the leg (deep vein thrombosis, or DVT) as a result of reduced movement; DVT can be prevented using special stockings, exercise and medication
• pressure ulcers (bedsores) – can occur on areas of skin under constant pressure from being in a chair or bed for long periods

Your surgeon will be able to discuss these and any other risks with you.

Preventing hip fractures

It may be possible to prevent hip fractures by taking steps to prevent falls and by treating osteoporosis.

You can reduce your risk of falling by:

• using walking aids, such as a walking stick
• assessing your home for hazards, such as loose carpeting, and making it safer
• using exercises to improve your balance

Read more about preventing falls.

Hip protectors

Hip protectors can be used to reduce the impact of a fall, and are particularly useful for preventing hip fractures in older people.

Hip protectors are padded material and plastic shields attached to specially designed underwear. The pads absorb the shock of a fall and the plastic shields divert the impact away from vulnerable areas of the hip.

In the past, one of the biggest issues with hip protectors was that many people found them uncomfortable and stopped wearing them. Modern hip protectors have tried to address this by having a more comfortable fit and additional features, such as ventilation to reduce sweating.

NICE suggests that hip protectors may be useful for older people in care homes who are considered to be at high risk of a fall. They're thought to be less effective for elderly people who remain active and live in their own home.

Read the full NICE guideline on falls: assessment and prevention of falls in older people.

The FRAX tool

The World Health Organization (WHO) has developed a 10-year Fracture Risk Assessment Tool to help predict a person's risk of fracture in the age range 40-90 years.

The tool is based on bone mineral density (BMD) and other relevant risk factors such as age and sex.

Social care and support guide

If you:

• need help with day-to-day living because of illness or disability
• care for someone regularly because they're ill, elderly or disabled - including family members

Our guide to care and support explains your options and where you can get support.