A hip fracture is a break at the top of the thigh bone (femur), most often from a fall. Femoral neck fractures happen just below the ball of the hip; intertrochanteric and subtrochanteric fractures happen a little lower. It causes severe hip or groin pain and makes standing or walking very hard. Surgery is usually done within a day or two so you can get up and walking quickly.
Which surgery is right for me?
Where the break is matters most. Fractures just below the ball (femoral neck) are treated differently from fractures a little lower (intertrochanteric or subtrochanteric).
Femoral neck fractures that haven't shifted, and those in younger patients, are usually fixed with a plate and screw system to keep your own hip. You'll protect the leg with limited weight for about 6 weeks.
Femoral neck fractures that have shifted, especially in older adults, usually need the ball replaced (a partial or total hip replacement), because the ball's blood supply is often damaged. You can usually put full weight on the leg right away.
Intertrochanteric and subtrochanteric fractures are usually fixed with a rod inside the thigh bone (a cephalomedullary nail), and you can usually put full weight on the leg right away.
Surgical options
Each option has its own patient education handout and PT protocol. Open, save or print.
Option 1
Femoral neck fixation
Usually chosen for: Femoral neck fractures that haven't shifted, or younger patients
Surgery is typically done soon after the injury to protect the blood supply to the ball. Through a small incision on the side of the hip, the bone is lined up and held with a femoral neck plate and screw system: a small side plate with screws and/or a larger bolt go up into the ball. Your own hip joint is kept. The final plan is determined during surgery.
Weight-bearing
Touch-down weight (foot flat, ~20 lb) with crutches or a walker for 6 weeks; no hip precautions. Some older adults with a stable fracture may put full weight on it right away.
Building up
After the 6-week x-rays, weight is added ~25% each week to full by 10–12 weeks. Crutches, then a cane, are stopped once the limp is gone.
Usually chosen for: Shifted femoral neck fractures, especially in older adults
Through an incision on the back and side of the hip (posterior approach), the broken ball is removed and a stem is placed in the thigh bone. In a hemiarthroplasty, a metal ball sits in your own socket; in a total hip replacement, the socket is also lined with a new cup. The final plan is determined during surgery.
Weight-bearing
Full weight as comfort allows with a walker, starting the day of or after surgery. Daily walking is your most important exercise.
Hip precautions
For 6 weeks, avoid bending the hip deeply while the knee crosses inward and turns in—such as a deep, low chair with knees together, crossing your legs, or twisting toward the surgical side. Stricter precautions only if your surgeon advises.
Usually chosen for: Intertrochanteric and subtrochanteric fractures
Surgery is typically done within a day or two of the injury so you can get up and walking quickly. Through small incisions on the side of the hip and thigh, the bone is lined up and a metal rod (nail) is placed inside the thigh bone, with a large screw up into the ball of the hip and sometimes a screw near the knee. The final plan is determined during surgery.
Weight-bearing
Full weight as comfort allows with a walker, starting the day of or after surgery. No hip precautions. (Some complex fractures need touch-down weight for several weeks.)
Walking
Walker for the first 2–6 weeks, then a cane as balance allows. The cane is stopped between 6 and 12 weeks, once the limp is gone.
