Hip Fracture in an Elderly Parent: What to Do First

The typical story is a simple fall at home: a slip in the bathroom or a missed step in the dark on the way to the toilet. In older people with thinner bones, that is enough to break the top of the thigh bone.

The signs families usually notice are:

• Pain in the groin or the outer side of the hip, sometimes felt down towards the knee.
• Not being able to stand or put weight on the leg, or being able to do so only with great pain.
• The injured leg looking shorter and the foot turned outwards as they lie on their back.

Two things catch families out. First, some hip fractures are “impacted”: the broken ends are jammed together, and the person can still walk a few painful steps. Being able to walk does not rule out a fracture. Second, in someone who is confused, has dementia or has had a stroke, the only sign may be that they refuse to stand or cry out when they are moved. Groin pain after a fall in an elderly person deserves an X-ray the same day, not a week of balm and rest.

The first job is to keep your parent comfortable and get them to a hospital with casualty and orthopaedic services.

• Do not try to get them walking to “see if it is all right”. A crack can become a fully displaced fracture.
• Keep them lying down with a pillow between the knees, warm and still. If you are in a building without a lift, an ambulance team with a stretcher is far safer than carrying someone down the stairs on a chair.
• Avoid sitting them upright in an auto or a car for the journey if you can. Lying flat is kinder to a broken hip.
• Do not massage the hip or take them to a bone-setter. Massage and pulling the leg only delay proper treatment.
• Hold off on a heavy meal until the doctors have seen them, because an anaesthetic may be planned. Small sips of water are usually fine; ask the casualty team.
• Bring their medicines and reports. A list of every tablet, especially blood thinners, diabetes and heart medicines, saves hours.

Also think about why they fell. A trip on a wet floor is one thing. A fall because they blacked out, felt chest pain or breathlessness, or suddenly could not move one side is a medical emergency in its own right, and the doctors need to know.

Any suspected hip fracture should be seen the same day. Call an ambulance and go to the nearest emergency department straight away if, along with the fall, there is:

• A head injury, especially in someone on blood thinners, or drowsiness, vomiting or confusion after the fall.
• Fainting, chest pain, palpitations or breathlessness before or after the fall.
• Sudden weakness of an arm or leg, a drooping face or slurred speech.
• A long time lying on the floor before being found: dehydration and muscle breakdown need treatment.
• A wound over the injured area with bone visible or heavy bleeding.

After surgery, contact the team urgently for calf pain or swelling, sudden breathlessness or chest pain (possible blood clot), fever with redness or discharge from the wound, new or worsening confusion, or a sudden return of severe hip pain with the leg turning outwards.

Families sometimes delay because a relative is travelling or a festival is on. I understand, but the clock matters: one family member can usually agree to the plan while others join by phone.

Families often ask, very reasonably, whether surgery is safe at eighty or ninety. My honest answer is that for a broken hip, the bigger risk is usually not operating. Lying in bed brings chest infections, bedsores, blood clots, confusion and muscle loss. The operation is what lets them sit up and stand again.

Current practice is to operate as soon as the patient is reasonably fit, ideally on the day of admission or the next day. The anaesthetist and physician check the heart, blood sugar, kidneys and blood count first, and some blood thinners need a short, planned pause. Age alone is not a reason to avoid surgery. Non-operative care is reserved for the few who are too unwell for any anaesthetic.

The operation depends on where the bone has broken:

• Fractures lower down, near the top of the thigh bone (intertrochanteric): usually fixed with a nail or a plate and screws, keeping the patient's own hip joint.
• Fractures of the neck of the femur that have shifted: usually treated by replacing the ball (a half hip replacement), or a total hip replacement for people who were fit, independent and active before the fall.
• Neck fractures that have not shifted: often held with screws, though in some older patients a replacement is the more reliable choice.

Most patients are allowed to put full weight on the leg straight after surgery. Early standing is part of the treatment.

Recovery is measured in months, not days.

• In hospital: standing with a walker on the first or second day after surgery, and usually going home within a few days to a week, depending on overall health.
• First six weeks: walker at home, daily exercises, help with bathing and the toilet. An Indian-style toilet is not practical now; a commode chair or raised seat makes life much easier and safer.
• Six to twelve weeks: many move from a walker to a stick. The bone itself typically takes around three months to heal, as I explain in how long a broken bone takes to heal.
• Three months to a year: strength and confidence keep improving. Many people get back to walking around the home and building independently. Some, particularly those who were already frail, do not regain their earlier level, and it is better to plan for that than to be surprised by it.

Short spells of confusion in the first days are common; a familiar face, their glasses and hearing aid, and a normal day-night routine help.

Just as important is the next fall. A hip fracture after a minor fall usually means the bones are weak, so ask about a bone density test and osteoporosis treatment before discharge. At home, add night lights on the way to the toilet, bathroom grab bars and non-slip mats. With Diwali cleaning underway, please keep older parents off stools and ladders.

Families looking for the best orthopaedic care in Mira Road after a parent's fall need a clear answer quickly and a surgeon who stays responsible throughout. Surgicare Plus offers excellent, fellowship-trained care for exactly this, and families come to us from across Mira Bhayandar, Vasai-Virar and Thane. I see every patient myself, from the first consultation through every follow-up.

If your parent has just fallen, go straight to an emergency department. If an X-ray has already been taken, you can WhatsApp it to +91 94219 91530 for a first opinion, and I will tell you honestly what it shows and how urgent it is.

Hip fracture surgery is done at our associated hospitals — Wockhardt Hospital, Gurukripa Hospital, Orbit Hospital and Apollo Spectra — where the patient can be checked by the physician and anaesthetist and operated on without unnecessary delay. Fixation with nails and plates, half hip replacement and total hip replacement are all part of my routine trauma and joint replacement work. My fellowship training includes joint replacement at Queen Mary Hospital, Hong Kong, and 3D printing in orthopaedics.

Families get an honest written estimate before surgery, and follow-up continues at the clinic at Shop No. 40-41, Poonam Cluster 2, Mira Road East, open Monday to Saturday, 10 am to 8 pm, and Sundays by appointment. More on the practice is on the Mira Road clinic page.