Occurs predominantly in older people. The risk increases significantly with age.
Associated most commonly with low-energy injury (e.g., fall from standing height) and osteoporosis or osteopenia.
Treatment is most commonly surgical. The choice of implant depends on the fracture pattern and the surgeon's preference.
A hip fracture is generally considered to be any fracture of the femur distal to the femoral head and proximal to a level a few centimetres below the lesser trochanter.
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
- older age
- low body mass index (BMI)
- female sex
- high-energy trauma
1st investigations to order
- plain radiographs
- full blood count
- urea and electrolytes
- group and save
- coagulation screen
Investigations to consider
- MRI pelvis
- CT pelvis
suitable for surgery
not currently suitable for surgery: not receiving end-of-life care
not currently suitable for surgery: receiving end of life care
ST6 in Trauma and Orthopaedics
Epsom and St Helier University Hospitals
ZL declares that she has no competing interests.
Norfolk and Norwich University Hospitals
BG declares that he has no competing interests.
ST4 in Trauma and Orthopaedics
Croydon University Hospital
HK declares she has no competing interests.
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
Consultant Orthopedic Surgeon
Orthopedic Trauma Service
Hamilton Health Sciences
Mohit Bhandari MD, PhD, FRCSC
Canada Research Chair in Musculoskeletal Trauma
Hamilton Health Sciences
BAP and MB declare that they have no competing interests.
University Hospital of Wales
AJ is clinical lead for the National Hip Fracture Database, Royal College of Physicians, London, UK.
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.
Section Editor, BMJ Best Practice
EQ declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Head of Research and Development, BMJ
LD declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
- Acetabular fracture
- Pubic rami fracture
- Femoral shaft or subtrochanteric femur fracture
- Hip fracture: management
- Management of proximal femoral fractures
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