Hip fractures

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

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 1 Jun 2025
Last updated: 09 Oct 2024

Summary

Definition

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

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.

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 - suspected fracture. 2018 [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.
  • 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
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer