Hip Fractures in the Elderly: A Family's Guide

A hip fracture in an elderly relative is one of the most stressful situations a family can face. The injury usually follows a low-energy fall — a stumble on a wet floor, a trip on a step — and arrives without warning into a household. The good news is that hip fracture care in modern units is remarkably effective: surgery is usually performed within 24–48 hours, mobilisation begins the same day, and most patients return home. This guide explains what happens, the operations involved, and how families can help during recovery.

What a hip fracture means

Despite the name, hip fractures rarely involve the pelvis. They are fractures of the top of the femur — either the femoral neck (the narrow part just below the ball) or the intertrochanteric region (the wider area below the neck where the bone curves out). The fracture pattern determines the operation.

The urgency of surgery

Modern best practice is to operate within 24–48 hours of admission for medically suitable patients. Delays beyond 48 hours are associated with higher complications, longer hospital stays, and higher mortality. The reason is that immobilising an elderly patient in bed for several days carries significant risks — chest infection, urinary infection, pressure sores, blood clots, and rapid muscle wasting — that surgery actively prevents.

The operations

For displaced femoral neck fractures

The blood supply to the femoral head is disrupted in displaced neck fractures, so internal fixation often fails to heal. The standard operations are:

• Hemiarthroplasty — the femoral head is replaced with a metal head on a stem; the socket is not replaced. Faster operation, well-tolerated, excellent for less active or frailer patients.
• Total hip replacement — both the femoral head and the socket are replaced. Preferred for fitter, more active patients with reasonable life expectancy because long-term function is better and revision rates are lower.

For intertrochanteric fractures

These usually heal well when fixed with implants that hold the fragments together. The standard implants are dynamic hip screws (a sliding plate-and-screw construct) or cephalomedullary nails (an intramedullary rod with a screw into the femoral head). Both work well; choice depends on fracture pattern.

Recovery: the first hospital days

Mobilisation typically starts on the day after surgery. The first morning is the hardest — pain medication is in place, a physiotherapist helps the patient sit out, stand, take a few steps with a frame. By the third or fourth day most patients are walking short distances. Discharge planning starts at admission.

Where will the patient go after hospital?

The options are home, with family or carer support, often a step-down rehabilitation facility for a week or two of focused therapy, or in some cases an extended-stay rehabilitation unit. The right answer depends on the patient’s pre-fracture function, the home environment, and the family’s capacity to support.

What family members can do

Family involvement is one of the strongest predictors of good outcomes. Practical contributions:

• Bring familiar items into hospital — glasses, hearing aids, dentures, comfortable clothes — these dramatically reduce delirium
• Encourage out-of-bed time during visits; sitting up and walking matter
• Help with meals — adequate nutrition is critical for healing
• Engage in conversation and gentle cognitive engagement (familiar music, photo albums)
• Plan the home environment in advance — clear pathways, raised toilet seat, grab rails in the bathroom, removed rugs
• Arrange for follow-up appointments and home physiotherapy

Recovery timeline at home

The first 6 weeks focus on safe transfers and walking with a frame. Weeks 6–12 see most patients progressing to a stick. By 3 months, many are back to most pre-fracture activities, though some loss of overall function is common in this population. The realistic goal is restoring independence rather than achieving exactly pre-fracture status.

The osteoporosis conversation

A hip fracture from a low-energy fall is the single strongest indicator of severe osteoporosis. Every patient should be started on a bone-protection treatment — almost always a bisphosphonate or denosumab, with calcium and vitamin D supplementation. This dramatically reduces the chance of a second fracture, which is otherwise common.

The hard conversations

Hip fractures in very frail elderly patients carry significant medical risks — mortality at one year is in the 20–30% range in this group, mostly related to background medical conditions rather than the fracture itself. Surgery is usually still the right answer because non-operative management has even higher mortality. Honest conversations with families about prognosis and goals of care are part of good orthopedic practice.