Synopsis
Recognise hip fracture promptly, relieve pain and prevent delirium, correct reversible barriers without avoidable delay, and deliver surgery, geriatric co-management, early weight bearing and secondary fracture prevention.
- Suspect hip fracture with groin pain, shortening, external rotation or inability to bear weight after a fall; impacted fractures may show little deformity and allow painful movement.
- Obtain AP pelvis and a true lateral hip radiograph promptly; if suspicion persists despite adequate negative films, offer MRI, or CT if MRI is unavailable within 24 hours or contraindicated.
- Assess pain immediately and within 30 minutes of analgesia, then regularly; NICE uses paracetamol every 6 hours, adding opioids and considering a trained nerve block when relief is inadequate.
Key red flags
A shortened externally rotated leg, inability to bear weight or new hip and groin pain after a fall should be treated as fracture even if initial radiographs are non-diagnostic.
Investigation priorities
Confirm fracture location, displacement and arthritic or pathological features.
Confirm a radiographically occult proximal femoral or pelvic insufficiency injury.
Management branches
An older person has suspected or confirmed hip fracture after a fall.
- Perform ABCDE, assess skin and distal neurology, obtain collateral baseline and give regular paracetamol with titrated additional analgesia.
- Obtain urgent radiographs, then MRI or timely CT for persistent occult-fracture suspicion and avoid testing weight bearing repeatedly.
Key medicines
ParacetamolGive 1 g orally or intravenously every 6 hours before and after surgery, maximum 4 g in 24 hours; reduce the maximum in adults under 50 kg or with frailty, malnutrition, chronic alcohol excess or hepatic risk.
Enoxaparin for postoperative hip-fracture prophylaxisWhen the local NG89 pathway selects enoxaparin and haemostasis is secure, give 40 mg subcutaneously once daily starting 6–12 hours after surgery and continue pharmacological prophylaxis for one month; use the product and renal-adjustment protocol.