Hip fractures

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources

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Evidence last reviewed: 24 Jun 2026
Topic last updated: 23 Jul 2026

Summary

Definition

History and exam

Key diagnostic factors

  • history of fall or trauma
  • inability to bear weight
  • pain in affected leg/hip
  • pain with hip movement
Full details

Other diagnostic factors

  • shortened and externally rotated leg
Full details

Risk factors

  • osteoporosis/osteopenia
  • age over 65 years
  • falls
  • low body mass index
  • female sex
  • high-energy trauma
  • use of certain drugs
  • ethnicity
  • dementia
Full details

Diagnostic tests

1st tests to order

  • plain x-rays
Full details

Tests to consider

  • MRI pelvis (without contrast)
  • CT pelvis (without contrast)
Full details

Treatment algorithm

ACUTE

intracapsular (femoral neck) fracture

extracapsular (intertrochanteric) fracture

Contributors

Expert advisers

Nicole M. Stevens, MD

Assistant Professor Orthopedic Trauma

Director, Fragility Fracture Service, NYU Langone Hospital - Long Island

Department of Orthopedic Surgery

NYU Langone Health-Long Island, NY

Disclosures

NMS declares that she has no competing interests.

Abhishek Ganta, MD FAAOS

Assistant Professor of Orthopedic Surgery, NYU Langone Health

Co-Director of Orthopedic Trauma, Medisys Health Network

Associate Program Director NYU Langone Orthopedics

NY

Disclosures

AG declares that he has no competing interests.

Acknowledgements

Dr Nicole M. Stevens and Dr Abhishek Ganta would like to gratefully acknowledge Dr Herman Johal, Dr Bradley A. Petrisor, and Dr Mohit Bhandari, the previous contributors to this topic.

Disclosures

HJ, BAP, and MB declare that they have no competing interests.

Peer reviewers

Marc F. Swiontkowski, MD

Professor

Department of Orthopedic Surgery

University of Minnesota

Minneapolis, MN

Disclosures

MFS is Editor-in-Chief of the Journal of Bone and Joint Surgery.

Rudolf Poolman, MD, PhD

Consultant Orthopaedic Surgeon

Onze Lieve Vrouwe Gasthuis

Teaching Hospital with The University of Amsterdam

Department of Orthopaedic Surgery

Amsterdam

The Netherlands

Disclosures

RP has been reimbursed by LINK for organizing education and research consultancy.

David Hackam, MD, PhD

Assistant Professor of Surgery

Children's Hospital of Pittsburgh

Pittsburgh, PA

Disclosures

DH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Academy of Orthopaedic Surgeons. Management of hip fractures in older adults: evidence-based clinical practice guideline. December 2021 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: acute hip pain. 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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