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Hip fracture: management (summary)
Clinical guideline [CG124] Published: 22 June 2011 Last updated: 06 January 2023
This guideline covers managing hip fracture in adults. It aims to improve care from the time people aged 18 and over are admitted to hospital through to when they return to the community. Recommendations emphasise the importance of early surgery and coordinating care through a multidisciplinary Hip Fracture Programme to help people recover faster and regain their mobility.
Offer MRI if hip fracture is suspected despite negative X‑rays of the hip of an adequate standard. If MRI is not available within 24 hours or is contraindicated, consider CT. [2011, amended 2014]
Assess the person’s pain:
immediately upon presentation at hospital and
within 30 minutes of administering initial analgesia and
hourly until settled on the ward and
regularly as part of routine nursing observations throughout admission. [2011]
Offer immediate analgesia to people presenting at hospital with suspected hip fracture, including people with cognitive impairment. [2011]
Ensure analgesia is sufficient to allow movements necessary for investigations (as indicated by the ability to tolerate passive external rotation of the leg), and for nursing care and rehabilitation. [2011]
Offer paracetamol every 6 hours preoperatively unless contraindicated. [2011]
Offer additional opioids if paracetamol alone does not provide sufficient preoperative pain relief. [2011]
Consider adding nerve blocks if paracetamol and opioids do not provide sufficient preoperative pain relief, or to limit opioid dosage. Nerve blocks should be administered by trained personnel. Do not use nerve blocks as a substitute for early surgery. [2011]
Offer paracetamol every 6 hours postoperatively unless contraindicated. [2011]
Offer additional opioids if paracetamol alone does not provide sufficient postoperative pain relief. [2011]
Non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended. [2011]
Perform surgery on the day of, or the day after, admission. [2011]
Operate on people with the aim to allow them to fully weight bear (without restriction) in the immediate postoperative period. [2011
Offer replacement arthroplasty (total hip replacement or hemiarthroplasty) to people with a displaced intracapsular hip fracture. [2017]
Consider total hip replacement rather than hemiarthroplasty for people with a displaced intracapsular hip fracture who:
were able to walk independently out of doors with no more than the use of a stick and
do not have a condition or comorbidity that makes the procedure unsuitable for them and
are expected to be able to carry out activities of daily living independently beyond 2 years. [2023]
Offer patients (or, as appropriate, their carer and/or family) verbal and printed information about treatment and care including:
diagnosis
choice of anaesthesia
choice of analgesia and other medications
surgical procedures
possible complications
postoperative care
rehabilitation programme
long-term outcomes
healthcare professionals involved. [2011]