Hip Fractures

A hip fracture is the most serious type of fragility fracture. It requires emergency surgery, carries significant risks, and can have a profound impact on independence and quality of life. In Ireland, hip fractures place a major burden on both individuals and the healthcare system.

Why Are Hip Fractures So Serious?

Unlike most fractures, hip fractures in older adults are associated with major systemic consequences:

• Immediate complications: Blood clots (deep vein thrombosis, pulmonary embolism), pneumonia, urinary tract infections, pressure sores — all related to sudden immobility
• High mortality: Up to 20–30% of older adults who sustain a hip fracture in Ireland die within the following 12 months. Men have a higher mortality rate than women.
• Loss of independence: Many people who could live independently before their hip fracture are unable to return home afterwards, requiring ongoing residential or nursing home care
• Pain and functional limitation: Even for those who recover well, chronic pain and reduced mobility are common

What Happens When Someone Has a Hip Fracture?

Emergency Presentation

Hip fractures are medical emergencies. Symptoms include:

• Sudden, severe pain in the hip or groin after a fall
• Inability to bear weight on the affected leg
• The leg may appear shortened and rotated outward

If you suspect someone has a hip fracture, call 999 / 112 immediately. Do not attempt to move the person.

Surgery

Almost all hip fractures in older adults require surgery. The type of surgery depends on the location and pattern of the fracture:

• Internal fixation (using metal screws, plates, or nails) — used to hold the broken bone in place while it heals; typically for fractures that have not displaced significantly
• Hemi-arthroplasty — replacement of the femoral head (ball of the hip joint) with a prosthesis; used when the blood supply to the bone head may be compromised
• Total hip replacement — replacement of both the ball and socket; may be considered in certain fracture types, particularly in more active, younger older adults

Irish and international guidelines recommend that surgery should take place within 24–48 hours of admission to minimise complications. Delays to surgery are associated with higher mortality and worse outcomes.

Rehabilitation

Rehabilitation begins as soon as possible after surgery — typically the morning after:

1. Day 1 post-surgery: Physiotherapist helps the patient sit up and start to mobilise (stand/walk with support)
2. Hospital: Progressive walking, stair practice, exercises to restore strength and confidence
3. Discharge: May go home with community physiotherapy support, or to an inpatient rehabilitation facility or nursing home
4. Outpatient rehabilitation: Continues for weeks to months after discharge; goals include returning to independent walking, daily activities, and reducing fall risk

Secondary Prevention After Hip Fracture

After a hip fracture, it is essential that bone density is assessed and appropriate treatment started to prevent a second fracture. In Ireland, some hospitals have Fracture Liaison Services (FLS) to coordinate this automatically. If you are not referred, ask specifically:

• “Has my bone density been assessed or will it be arranged?”
• “Should I be starting bone-protective medication?”
• “Will I receive a referral to a Fracture Liaison Service?”

Read more on our Secondary Fracture Prevention page.

For Family Members and Carers

If your family member has had a hip fracture, your role in their recovery is important:

• Attend rehabilitation sessions where possible — understanding the exercises helps you support them at home
• Help ensure the home is made safe before discharge (grab rails, removal of trip hazards, lighting)
• Ask the hospital social work team about any entitlement to home care support packages through the HSE
• Encourage and assist with prescribed exercises, but do not push beyond what has been recommended
• Monitor for signs of depression or excessive fear of activity, which are common after hip fractures