Hip fracture in older adults: why surgery shouldn't wait

Why a hip fracture is so dangerous

In older people bones become fragile, and a fracture can happen even after a fall from standing height. The fracture rarely heals properly without surgery, and long bed rest brings the risk of pressure sores, pneumonia and blood clots. So the aim of treatment is to get the person back on their feet as soon as possible.

What research says about timing

A Canadian study published in JAMA analysed more than 42,000 hip fracture operations. When surgery took place more than 24 hours after arrival, 30-day mortality was higher: 6.5% versus 5.8% ^[1].

The large international HIP ATTACK randomised trial compared very early surgery with standard timing. Speeding surgery up did not reduce mortality or major complications ^[2]. So there is no need to race the clock, but delaying for several days isn't wise either — what matters is preparing the patient for surgery quickly and safely.

Types of surgery

• internal fixation — holding the fragments together with screws or metal implants;
• joint replacement — replacing the hip with an artificial joint, more often in older patients with displaced fractures.

After surgery

We aim to get patients up as early as possible — usually the next day, with a walker and a rehab instructor. At Gavhar Clinic, X-ray, intensive care, the ward and the rehab gym are in one building, so the whole journey from admission to discharge happens without transfers.