Synopsis
Deliver rapid, humane and coordinated care from suspected fracture through surgery and recovery, balancing analgesia, anticoagulation, delirium, comorbidity, nutrition, mobility, bone health and the person's pre-fracture goals.
- First-line suspected hip-fracture care is analgesia, safe positioning, pressure care, radiographs and admission to a coordinated orthopaedic–orthogeriatric pathway.
- MRI is the reference test when hip fracture remains suspected after adequate negative radiographs; use CT if MRI is contraindicated or unavailable within 24 hours.
- Offer immediate regular paracetamol unless contraindicated, add opioids when needed and use nerve block to limit opioid dose; NICE advises against NSAIDs in hip-fracture care.
Key red flags
Haemodynamic instability, major blood loss, hypoxia or another life-threatening injury requires immediate resuscitation while the fracture pathway continues.
Groin pain, inability to weight bear and a shortened externally rotated limb after a fall is highly concerning.
Investigation priorities
Confirm and classify suspected fracture first line.
Management branches
Hip fracture is suspected or confirmed.
- Give analgesia, protect pressure areas, obtain radiographs and use MRI or CT promptly for occult fracture.
- Admit to coordinated hip-fracture care and document baseline, comorbidity, cognition, medicines and goals.
Key medicines
ParacetamolA common adult regimen is 1 g orally or intravenously every six hours, maximum 4 g in 24 hours; use a lower maximum or longer interval for body weight under 50 kg, malnutrition, liver risk or other product-specific factors.
Immediate-release opioidUse a small titrated oral or intravenous dose according to local protocol and prior exposure; reduce and lengthen dosing in frailty or renal impairment and reassess after each dose.