Hip fractures

Last updated: November 21, 2022

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Hip fractures are classified according to their anatomical location as intracapsular, which involves the femoral head and neck, and extracapsular, which includes intertrochanteric, trochanteric, and subtrochanteric fractures. A low impact fall is the typical mechanism of injury in older adults and is often associated with underlying osteoporosis. Motor vehicle accidents are typical in younger individuals. Clinical features include groin pain and deformity of the hip. An x-ray is usually diagnostic, while an MRI may be required to confirm a pathological fracture. Surgical therapy is usually considered definitive treatment, especially for unstable or displaced hip fractures. Thromboembolism and avascular necrosis are the most common and serious complications.

Hip fractures, especially fractures of the femoral head, are often associated with a hip dislocation. Posterior hip dislocations account for 90% of hip dislocations and typically follow a dashboard injury. Early reduction is vital to avoid vascular compromise and sciatic nerve injury.


Epidemiological data refers to the US, unless otherwise specified.


Diagnostics [3]

If hip fracture is suspected, perform a detailed evaluation to determine the cause and identify other injuries.

Management [7][8]

Operative intervention within 48 hours of admission may be associated with improved patient outcomes.

Weight-bearing status is determined by orthopedics. Clarify weight-bearing precautions and range of motion prior to consulting physical and occupational therapy.

Hip fractures are divided into:

  • Intracapsular
    • Femoral head
    • Femoral neck
  • Extracapsular
    • Trochanteric
    • Intertrochanteric
    • Subtrochanteric

Pipkin Classification
Description Treatment after rapid repositioning
Pipkin I
Pipkin II
Pipkin III
Pipkin IV

A patient with an MVA dashboard injury may present with a femoral head fracture and hip dislocation.

Watch out for sciatic nerve injury in patients with femoral head fractures.

Garden Classification
Garden I

Nondisplaced, incomplete, impaction fracture

Garden II

Complete, but nondisplaced fracture

Garden III

Partially displaced, complete fracture with medial contact of the fracture elements and varus displacement of the femoral head

Garden IV

Entirely displaced, complete fracture

Posterior vs. anterior hip dislocation
Type of hip dislocation Etiology Clinical features Diagnostics Treatment Complications
Posterior hip dislocation (90% of cases)
  • Dashboard injury in which a posteriorly directed force (e.g., dashboard during a motor vehicle accident) is directed towards an internally rotated, flexed, and adducted hip
Anterior hip dislocation (10% of cases)

Fracture dislocations are at greatest risk of avascular necrosis of the femoral head.

Thrombolytic therapy reduces the risk of deep vein thrombosis in patients with hip fractures.

We list the most important complications. The selection is not exhaustive.

Hip fractures have a high rate of associated morbidity and mortality in older adults.

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  4. Femoral Neck Fractures. http://www.orthobullets.com/trauma/1037/femoral-neck-fractures. Updated: December 12, 2016. Accessed: December 12, 2016.
  5. Management of hip fractures in the elderly. http://www.orthoguidelines.org/topic?id=1017. Updated: September 5, 2014. Accessed: April 7, 2019.
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  7. Ross AB, Lee KS, Chang EY, et al. ACR Appropriateness Criteria® Acute Hip Pain-Suspected Fracture. J Am Coll Radiol. 2019; 16 (5): p.S18-S25. doi: 10.1016/j.jacr.2019.02.028 . | Open in Read by QxMD
  8. Rebolledo BJ, Unnanuntana A, Lane JM. A Comprehensive Approach to Fragility Fractures. J Orthop Trauma. 2011; 25 (9): p.566-573. doi: 10.1097/bot.0b013e3181f9b389 . | Open in Read by QxMD
  9. Parker M, Johansen A. Hip fracture. BMJ. 2006; 333 (7557): p.27-30. doi: 10.1136/bmj.333.7557.27 . | Open in Read by QxMD
  10. Ackermann L, Schwenk ES, Lev Y, Weitz H. Update on medical management of acute hip fracture. Cleve Clin J Med. 2021; 88 (4): p.237-247. doi: 10.3949/ccjm.88a.20149 . | Open in Read by QxMD
  11. American Academy of Orthopaedic Surgeons Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline. https://www.aaos.org/hipfxcpg. Updated: December 3, 2021. Accessed: June 30, 2022.
  12. Falck-ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141 (Suppl 2): p.e278S-325S. doi: 10.1378/chest.11-2404 . | Open in Read by QxMD
  13. Conley RB, Adib G, Adler RA, et al. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Bone Miner Res. 2019; 35 (1): p.36-52. doi: 10.1002/jbmr.3877 . | Open in Read by QxMD

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