Hip Fracture · Internal Fixation vs Arthroplasty

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Site + displacement + age/mobility
   Femoral neck or intertrochanteric? Displaced? Age/mobility?
   • Femoral neck, non-displaced/impacted → Femoral neck non-displaced → internal fixation
   • Femoral neck, displaced, elderly → Femoral neck displaced + elderly → arthroplasty
   • Femoral neck, displaced, young (<60–65) → Femoral neck displaced + young → emergency ORIF
   • Intertrochanteric/subtrochanteric → Intertrochanteric → nail/SHS
2. [End] Femoral neck non-displaced → internal fixation
   Femoral neck non-displaced/impacted → internal fixation (cannulated screws/sliding hip screw); operate early (24–48 h), osteoporosis treatment.
3. [End] Femoral neck displaced + elderly → arthroplasty
   Femoral neck displaced + elderly → arthroplasty: poor mobility/low demand → hemiarthroplasty; good mobility/independent → total hip arthroplasty (better function, fewer revisions).
4. [End] Femoral neck displaced + young → emergency ORIF
   Femoral neck displaced + young → emergency anatomic reduction + internal fixation preserving the femoral head (reduces avascular necrosis/nonunion); delay increases necrosis risk.
5. [End] Intertrochanteric → nail/SHS
   Intertrochanteric/subtrochanteric → intramedullary nail (cephalomedullary); stable patterns may use a sliding hip screw (SHS); operate early, osteoporosis treatment, early weight-bearing rehabilitation.

Source guidelines & references

• Hip fracture management (AAOS; NICE hip fracture guideline)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways