First Aid & Emergencies

The goal of treatment for hip fractures is to allow you to do, without pain, most of the things you did before your fracture. The most common and almost always the best treatment for a hip fracture is surgery. Surgery helps make sure that the bones are lined up to heal correctly.

After your hip fracture is diagnosed, you may have a pillow placed under the knee of your injured leg. Or you may be placed in gentle skin traction to help keep you more comfortable until surgery. Skin traction attaches a light weight to your leg using tape, straps, or a special boot. And this weight provides a constant pull on your leg.

Surgery is done as soon as possible after a diagnosis of hip fracture, often within 24 hours. Having surgery right away can help shorten your stay in the hospital and may decrease pain and complications.¹ But in some cases, surgery may be delayed for 1 to 2 days for treatment of other medical problems, such as heart or lung conditions, so that surgery will be less risky.

There are different types of surgery for hip fractures, depending on the location of the break, the position of the bone fragments, and your age. Surgery for a hip fracture may include one of the following:

• Internal fixation. Internal fixation involves stabilizing broken bones with surgical screws, rods, or plates. This type of surgery is usually for people who have fractures in which the bones can be properly aligned. See Hip Fracture Repair (Hip Pinning) for more information.
• Hip replacement surgery (arthroplasty). Arthroplasty involves replacing part or all of the joint with artificial (usually metal) parts. A partial hip replacement may be done to replace the broken upper part of the thighbone (femur) with artificial parts. In some cases, a total hip replacement can be done if the hip joint area was already damaged before the fracture by arthritis or an injury and the joint was not working correctly. Arthroplasty is often done for femoral neck fractures when the blood supply to the top of the thighbone is damaged and there is a chance that the bone might die (avascular necrosis). And arthroplasty is often done when the fractured bones cannot be properly aligned. See Hip Replacement Surgery for more information.

Reduction (getting the bone lined up correctly) and internal fixation (stabilizing broken bones) often are done on younger, active people. Hip replacement surgery often is done on older, less active adults. In deciding which of these methods to use for repairing a hip fracture, your surgeon will consider the type of fracture, your age and activity level, and also the possible trade-offs. Research on displaced hip fractures (where the bones are not aligned) shows that, in the long term, total hip replacements may need to be redone less often than internal fixation, but there is also more time in surgery, a greater chance of infection, and possibly a greater chance of death from hip-replacement complications.²