Hip fracture

Last reviewed: 9 Nov 2022
Last updated: 17 Feb 2020

Summary

Definition

History and exam

Key diagnostic factors

  • history of fall or trauma
  • pain in the affected hip, groin, or thigh
  • inability to bear weight or move the hip
  • shortened, externally rotated leg
  • risk factors
Full details

Risk factors

  • osteoporosis/osteopenia
  • older age
  • falls
  • low body mass index (BMI)
  • female sex
  • high-energy trauma
Full details

Diagnostic investigations

1st investigations to order

  • plain radiographs
  • full blood count
  • urea and electrolytes
  • glucose
  • group and save
  • coagulation screen
  • ECG
Full details

Investigations to consider

  • MRI pelvis
  • CT pelvis
Full details

Treatment algorithm

ACUTE

suitable for surgery

not currently suitable for surgery: not receiving end-of-life care

not currently suitable for surgery: receiving end of life care

ONGOING

post-surgery

Contributors

Expert advisers

Zoe Little

ST6 in Trauma and Orthopaedics

Epsom and St Helier University Hospitals

Epsom

UK

Disclosures

ZL declares that she has no competing interests.

Brett Griffiths

Specialist Registrar

Norfolk and Norwich University Hospitals

Norwich

UK

Disclosures

BG declares that he has no competing interests.

Hiba Khan

ST4 in Trauma and Orthopaedics

Croydon University Hospital

London

UK

Disclosures

HK declares she has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Bradley A. Petrisor MSc, MD, FRCSC

Associate Professor

McMaster University

Consultant Orthopedic Surgeon

Orthopedic Trauma Service

Hamilton Health Sciences

Ontario

Canada

Mohit Bhandari MD, PhD, FRCSC

Professor

McMaster University

Canada Research Chair in Musculoskeletal Trauma

Hamilton Health Sciences

Ontario

Canada

Disclosures

BAP and MB declare that they have no competing interests.

Peer reviewers

Antony Johansen

Consultant Orthogeriatrician

University Hospital of Wales

Cardiff

UK

Biography

AJ is clinical lead for the National Hip Fracture Database, Royal College of Physicians, London, UK.

Disclosures

AJ has been a co-applicant or collaborator in successful applications for non-commercial grants from the NIHR Health Technology Assessment Programme, Physiotherapy Research Foundation, and Versus Arthritis.

Editors

Emma Quigley

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Rachel Wheeler

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Luisa Dillner

Head of Research and Development, BMJ

Disclosures

LD declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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