Hip Fracture in Older Adults: Surgical Repair & Recovery

Overview

Hip fracture is one of the most serious injuries affecting older adults, with approximately 20,000 Australians sustaining a hip fracture each year. Despite being a common injury, it carries significant morbidity and mortality, up to 30% of patients do not survive the year following a hip fracture, largely due to pre-existing frailty and complications of immobility.

Prompt surgical treatment and aggressive rehabilitation are essential to give patients the best possible outcome.

Types of Hip Fracture

Neck of femur (NOF) fractures occur within the capsule of the hip joint, between the femoral head and the greater trochanter. They risk disrupting the blood supply to the femoral head, leading to avascular necrosis.

Intertrochanteric fractures occur below the femoral neck, in a well-vascularised region. They typically heal well with fixation.

Subtrochanteric fractures occur below the lesser trochanter and are less common but biomechanically challenging to stabilise.

Surgical Treatment

Surgery should be performed within 24–48 hours of admission wherever medically possible, delay increases the risk of complications including pressure sores, pneumonia, and deep vein thrombosis.

For displaced NOF fractures, hemiarthroplasty (replacement of the femoral head with a prosthesis) is the most common surgery in older adults, as it avoids the risk of avascular necrosis. Total hip replacement may be preferred in active, independent patients.

Intertrochanteric fractures are typically treated with a dynamic hip screw or intramedullary nail, compressing the fracture fragments and allowing early weight-bearing.

Recovery and Rehabilitation

Early weight-bearing (within 24 hours of surgery) is encouraged wherever possible. Inpatient rehabilitation is essential, focusing on mobility, balance, and transferring. Many patients require a period of residential rehabilitation before returning home.

Falls risk assessment and prevention is a critical part of care, osteoporosis should be identified and treated to reduce the risk of future fractures.

Prevention

Strategies to prevent hip fracture include: treatment of osteoporosis with calcium, vitamin D, and bone-active medications; fall prevention programs; home modification; and hip protectors for high-risk individuals in residential care.