After the Fall: How Hip Fractures Are Treated and What Comes Next (Part Two)
By Orthopedic Surgeon James Slauterbeck, MD
When a hip fracture happens, quick treatment is very important. Surgery and proper medical care can improve recovery and reduce the risk of future fractures. Most hip fractures are treated with surgery, usually within 48 hours. Early surgery helps reduce pain, shorten hospital stay, and lower the risk of death. Hip fractures are divided into two main types: femoral neck fractures, which occur inside the joint, and intertrochanteric or subtrochanteric fractures, which occur outside the joint. The type of fracture determines the treatment approach.
For femoral neck fractures that are not displaced, surgeons often use screws to hold the bone in place. This allows the patient to keep their natural hip. For displaced fractures, hip replacement is commonly performed, especially if arthritis is present. Hemiarthroplasty replaces only the ball of the hip and has a lower dislocation risk. It has about a 9-year implant survival and is often used for less active patients without arthritis. Total hip replacement replaces both the ball and socket. It provides better function and quality of life, but it has a higher dislocation risk. It is usually recommended for more active and healthier patients with arthritis.
Fractures outside the joint are usually treated with metal plates and screws or nails. These devices provide stability and allow the bone to heal properly and allow the patient to move their hip and begin to weight-bear again with some restrictions.
After a hip fracture, treating osteoporosis is critical to prevent future fractures. Bisphosphonates are the most common first-line treatment and reduce hip and spine fractures significantly. These medications can be taken by mouth or by IV. Denosumab is another option, given as an injection every six months, and it reduces hip fractures significantly over 36 months. For patients at very high fracture risk, anabolic medications (teriparatide, abaloparatide, and romosozumab) that build new bone may be used.
In postmenopausal women, hormone therapy can also reduce fracture risk. In one study, women who took calcium, vitamin D, and hormone therapy had a 42 percent reduction in hip fractures compared to those taking calcium and vitamin D alone.
Recovery after a hip fracture requires a full team approach. Physical therapy helps restore strength and movement, while occupational therapy helps patients return to daily activities. Good nutrition supports healing, and pain control must be balanced to avoid sedation and further falls. Early movement after surgery helps prevent complications such as blood clots and pneumonia.
After one hip fracture, the risk of another is high, so prevention is essential. This includes osteoporosis treatment, balance training such as tai chi, home safety changes, vision correction, and careful review of medications. Hip fractures are serious, but treatment has improved. With the right care, many patients can recover and maintain independence. The best results come from combining surgery, medication, rehabilitation, and prevention strategies.
James Slauterbeck, MD, is an orthopedic surgeon whose special interests include sports medicine, adolescent sports medicine, female sports medicine, and high school and college athletic injuries. He is affiliated with UNC Health Orthopedics at Southeastern Health Park and UNC Health Southeastern. To learn more, call (910) 738-1065 or visit https://www.unchealth.org/care-services/doctors/s/james-r-slauterbeck-md.
