Hip fractures

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 25 Oct 2024

Last updated: 09 Oct 2024

Hip fractures occur 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.

Definition

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 centimeters below the lesser trochanter.

History and exam

Key diagnostic factors

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
medications
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)
technetium bone scan

Full details

Treatment algorithm

ACUTE

intracapsular (femoral neck) fracture

extracapsular (intertrochanteric) fracture

Contributors

Expert advisers

Herman Johal, MD, MPH, FRCSC

Orthopaedic Trauma Surgeon

Assistant Professor

Department of Surgery

McMaster University

Hamilton, Ontario

Canada

Disclosures

HJ declares that he has no competing interests.

Acknowledgements

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

Disclosures

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

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

Disclosures

DH declares that he has no competing interests.

$Hip fractures images$
Differentials
- Acetabular fracture
- Pubic rami fracture
- Femoral shaft or subtrochanteric femur fracture
More Differentials
Guidelines
- Prevention of surgical site infections after major extremity trauma: appropriate use criteria
- Perioperative management of antithrombotic therapy
More Guidelines
Patient information
Osteoporosis
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Hip fractures

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

intracapsular (femoral neck) fracture

extracapsular (intertrochanteric) fracture

Contributors

Expert advisers

Herman Johal, MD, MPH, FRCSC

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Marc F. Swiontkowski, MD

Disclosures

Rudolf Poolman, MD, PhD

Disclosures

David Hackam, MD, PhD

Disclosures

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice