Hip Fracture in the Elderly: Why It Is an Emergency

A hip fracture in an older person is an emergency, not an injury that can wait. Surgery is usually needed quickly, because the danger comes as much from lying still as from the broken bone itself.

Why hip fractures happen in older people

Most hip fractures in the elderly come from a simple fall at home. Not a bad fall. Standing up from a chair, slipping in the bathroom, missing the last step.

Two things make that ordinary fall break a bone. The first is osteoporosis, where bone loses density with age and becomes easier to break. The second is balance. Eyesight, reaction time, muscle strength and some medicines all affect balance, and all change with age.

Women are affected more often, because bone loss speeds up after menopause.

Signs of a hip fracture

After a fall, these point to a broken hip.

• Severe pain in the hip or groin.
• Not being able to stand or put weight on the leg.
• The leg on that side looking shorter, or turned outwards.
• Bruising and swelling around the hip.
• Cold toes on that leg, which can mean blood flow is affected.

Not every hip fracture stops someone walking. A small crack can still allow a few painful steps. If an older person falls and then has hip or groin pain, get an X-ray even if they can walk.

Why time matters so much

This is the part people underestimate. The broken bone is a problem, but the bigger danger is what happens to the body while it lies still waiting.

An older person confined to bed can develop serious complications quickly. Surgery is usually done as soon as the person is medically fit, often within the first day or two, because getting them upright again is what prevents these problems.

• Chest infection. Lying flat makes it harder to clear the lungs.
• Blood clots in the leg veins, which can travel to the lungs.
• Pressure sores. Skin over the hips, heels and lower back breaks down within days.
• Urine infection, especially if a catheter is needed.
• Confusion. Common in older patients who are in pain, in an unfamiliar place, and not moving.
• Muscle loss. Strength falls fast with bed rest and is slow to rebuild.

An untreated hip fracture in an older person is dangerous. This is not an injury to manage at home with painkillers and rest.

What to do straight away

1. Do not try to make them stand or walk. If the hip is broken, moving it can shift the bone.
2. Keep them still and warm, lying as comfortably as possible.
3. Do not give food or water. If surgery is needed, an empty stomach is required for the anaesthetic. Food can delay the operation.
4. Go to hospital. Use an ambulance if you can, rather than moving them yourself in a car.
5. Take the medicine list. Blood thinners especially, because they change when surgery can be done safely.

How hip fractures are treated

The treatment depends on where the bone has broken and the age and activity of the patient.

Some fractures are fixed with screws or a plate, keeping the patient’s own hip joint. Others, particularly breaks through the ball of the hip in older patients, are better treated by replacing the broken part. That is a partial hip replacement. In some cases a full total hip replacement is the better choice.

The aim in every case is the same: a hip that can take weight quickly, so the person can get out of bed.

Recovery

Getting up and moving starts early, usually with a walker and a physiotherapist. This is not being rushed. Early movement is the treatment for most of the complications listed above.

Recovery is slower than after planned surgery, because the patient did not choose the timing and was not prepared for it. Family support matters a great deal here. So does making sure they eat properly, because appetite often drops and healing needs protein.

Preventing the next fall

Someone who has fractured one hip is at higher risk of fracturing the other. The fall risk and the bone strength both need attention.

• Ask for a bone density check and treatment for osteoporosis if needed.
• Check vitamin D and calcium.
• Review medicines with the doctor. Some cause dizziness or low blood pressure on standing.
• Get eyesight checked, and keep spectacles up to date.
• Remove loose rugs and trailing wires. Light the route to the bathroom at night.
• Fit grab rails in the bathroom and beside the toilet.
• Keep walking. Strength and balance both improve with use, at any age.

Frequently asked questions

How urgent is surgery for a hip fracture?

It is treated as an emergency. Surgery is usually done as soon as the patient is medically fit, often within the first day or two. The reason is that lying still causes chest infections, blood clots, pressure sores and rapid muscle loss in older people. Getting them upright again is the point of operating quickly.

Can a hip fracture heal without surgery?

Very rarely, and only in specific situations decided by the surgeon. For most hip fractures in older adults, non surgical treatment means weeks of bed rest, which carries a higher risk than the operation does.

Can they still walk if the hip is broken?

Sometimes yes. A crack that has not displaced can still allow a few painful steps, which is why fractures get missed. If an older person has hip or groin pain after a fall, get an X-ray even if they are walking.

Will they walk again after a hip fracture?

Many do, and early surgery followed by early movement gives the best chance. Recovery depends on how well they walked before the fall, their general health, and how much support they get at home. Honest expectations are better set after the operation.

What causes cold toes after a hip injury?

It can mean blood flow to the leg is affected, and it needs to be checked urgently in hospital. Do not wait to see if it settles.

Get help quickly

If an older person has fallen and cannot bear weight, take them to the nearest emergency department now. For follow up care, fracture surgery and osteoporosis assessment in Surat, call +91 6355 991 466 or read more about fracture and trauma surgery.

Trusted sources and further reading

This article is general information reviewed by Dr Dev Padia. For more on the conditions and treatments mentioned, see the pages below.

• Fracture and trauma surgery — the full range of fracture care.
• Partial hip replacement — a common treatment for hip fracture.
• OrthoInfo: Hip Fractures — American Academy of Orthopaedic Surgeons.
• NHS: Broken hip — UK National Health Service.

The information on this website is for general guidance and does not replace a personal medical consultation. Please consult a qualified doctor about your own symptoms.