Treatment Overview

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

Surgery usually is the most effective treatment for a hip fracture. But in most cases you won't regain all of the mobility that you had before the hip fracture. If you have other health problems and haven't stayed active, you have a greater chance of complications after surgery. Complications include infection of the hip or the urinary tract, deep vein thrombosis, pulmonary embolism, pneumonia, and ulcers. Many of these complications may result from bed rest and inactivity after surgery.

In rare cases, surgery is not done. For example, surgery is not done in people who are at high risk for complications during or after surgery and who may not benefit significantly from surgery, such as those who were unable to walk before the hip fracture and who have minimal pain. In these cases, your doctor will use medicine to manage your pain.

What to expect after surgery

There are many issues to consider after hip surgery. Older adults often need extensive care, including physical therapy and help with cooking, taking medicine, and personal care. Anticoagulant medicines are prescribed to reduce the risk of blood clots and associated stroke, pulmonary embolism, or thrombophlebitis. You will probably keep taking this medicine until you are walking frequently and well. This often takes at least 3 weeks.

After hip fracture surgery, your doctor will encourage you to participate in a rehabilitation (rehab) program. Research shows that 6 months of outpatient rehab that includes strength training can improve quality of life and reduce disability.³ Following a rehab program is very important because it will speed up your recovery and allow you to return to daily activities sooner.

If your hip fracture was from bone thinning of osteoporosis or another cause, your doctor may suggest that you take medicines such as bisphosphonates to help prevent another fracture.⁴

After a hip fracture, some people can never again be as independent as they were before the fracture. They may need to use a walker or cane to walk. They may need help with daily activities such as dressing and bathing. And many can no longer live on their own. It is hard to recover from a hip fracture. So be sure to do all you can to keep your bones strong and to avoid falls that can lead to a fracture. And if you do break your hip, work hard to get your strength and mobility back so you can be as independent as possible.

Prevention

There are steps you can take to help prevent a hip fracture.

Keep your bones strong

Eat nutritious foods that include adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones. Vitamin D is vital for calcium absorption in bones and to improve muscle strength. Getting more vitamin D may help prevent falls in older people who are low in vitamin D.⁵ And some studies show that taking vitamin D may reduce the chances of breaking a bone.⁶ Talk to your doctor about measuring your vitamin D to be sure you are getting enough. The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.

Exercising and staying active help you keep your bone strength. Weight-bearing exercises such as walking, jogging, and light weight training help to minimize bone loss. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have been inactive. One study showed that moderate physical activity, such as walking, was linked to a substantially lowered number of hip fractures in postmenopausal women.⁷

Don't drink more than 2 alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are a woman. Drinking more than this puts you at higher risk for osteoporosis. Alcohol use also raises your risk of falling and breaking a bone. See pictures of standard alcoholic drinks.

Don't smoke. Smoking puts you at a higher risk for osteoporosis and increases the rate of bone thinning after it starts.

Talk to your doctor about taking hormone replacement therapy or other medicines if you are at risk for osteoporosis. Some doctors recommend hormone therapy for osteoporosis, although its risks and benefits should be considered. Other medicines such as bisphosphonates, including alendronate (Fosamax) and zoledronic acid (Reclast); raloxifene (Evista); and calcitonin (Calcimar or Miacalcin) are also used to prevent or treat osteoporosis. Studies show that the bisphosphonates, in particular, significantly reduced the risk of hip fracture in older women who have osteoporosis.⁸ For more information, see the topic Osteoporosis.

For more information, see the topics Fitnessand Healthy Eating.

Avoid falls

Almost all hip fractures in older adults happen because of a fall. Things that increase your chance of falling include:

• Having poor balance and coordination.
• Having weakness in one or both legs.
• Using certain medicines that may cause sleepiness, weakness, or dizziness.
• Having vision problems.
• Drinking too much alcohol.
• Feeling confused or having impaired reasoning (caused by age or conditions such as dementia).

You can reduce your risk for falls by:

• Removing anything in your house that may cause you to fall. Household hazards that can cause falls include slippery floors, cords, poor lighting, cluttered walkways, furniture placement that does not allow a clear pathway for walking, and throw rugs.
• Using nonslip mats and grab bars in the bathtub and shower.
• Making sure stairways have handrails. Having rails on both sides of the stairs is best. Also be sure to turn on the lights when you use the stairs.
• Making sure you have enough light to see obstacles or pets as you move around your home.
• Exercising to help you keep your strength and balance.
• Taking medicines only as directed and periodically reviewing your medicines with your primary care doctor, especially if you have more than one doctor. Some medicines, such as sleeping pills or pain relievers, can increase your risk of falling.
• Wearing low-heeled shoes that fit well.
• Using walking aids correctly.

For more information, see the topic Preventing Falls.