🚑RECOGNITION & ED — Hip Fracture Is a Surgical Emergency
Hip fracture in an older adult is a surgical emergency. Recognition is straightforward but the cost of missing it (or trying to walk on it) is high. The classic pattern: hip / groin / thigh pain after a fall, inability to bear weight, leg shortened and externally rotated. But sometimes the mechanism is minor or absent (a step off a curb, getting out of a chair, even no obvious injury in an osteoporotic patient — "occult" hip fracture). Do NOT walk on a possibly fractured hip — call EMS or go to the ED. Imaging may be needed even when initial X-ray is negative (MRI catches occult hip fractures). Same-day or next-day surgery is associated with lower mortality and better outcomes than delay.
🎯Three Phases · One Force Field
Every square belongs to one of three phases of mastery. Inside each square's detail panel, the four sections — Concepts · Skills · Actions · Plan — are the building blocks of these phases.
📘 Learn It Tier 1 · Aware
Identity earned: Self-Advocate. The "know" — what a hip fracture is (a surgical emergency with 20–30% one-year mortality), the recognition rule (hip / groin / thigh pain + inability to bear weight = ED), the surgical pathway (same-day or next-day surgery; type by location — femoral neck, intertrochanteric, subtrochanteric), and the honest framing that the recovery trajectory determines whether independence is preserved.
🛠 Live It Tier 2 · Active
Identity earned: Care-Team Member. The "do" — daily skills (early mobilization within 24 hours, DVT prophylaxis, delirium prevention, pain management balance, PT-guided weight-bearing progression, protein-adequate nutrition, falls prevention) and this-week actions that turn skills into habits — including building the family Ambassador partnership for the surgery-to-home continuum.
📣 Share It Tier 3 · Certified
Identity earned: Ambassador. The "carry forward" — handle hip-fracture-recovery identity honestly, mentor a newly-injured peer via BHOF, close the post-fracture treatment gap (insist on a bone-health plan before discharge — most patients leave without one), bridge into RRPS Certification for community fall-prevention work, navigate the AA mortality disparity and rural / SNF-placement disparities.
🛡️Your Force Field — 16 Squares
Click any square to open its detail panel. Each square is a tile in your shield. Keep clicking, learning, and acting — your Force Field gets stronger every step.
What Is a Hip Fracture?
A fragility fracture of the proximal femur in an older adult — usually from a fall from standing height or less. Surgical emergency: one-year mortality 20–30% in real-world cohorts; same-day or next-day surgery is the standard. The recovery trajectory (home → SNF → IRF) determines whether the patient returns to independence or institutionalization. Geriatric Co-Management improves outcomes meaningfully.
Primer360 Human Anatomy
Proximal Femur, Hip Joint, Vascular Supply
The proximal femur has three common fracture zones: femoral neck (intracapsular — disrupts vascular supply to femoral head; risk of avascular necrosis), intertrochanteric (extracapsular — between greater and lesser trochanter), and subtrochanteric (below lesser trochanter). The medial circumflex femoral artery supplies the femoral head and is vulnerable in femoral neck fractures — which drives surgical choice (hemiarthroplasty / total hip arthroplasty for displaced femoral neck vs ORIF for intertrochanteric).
AnatomyWho Gets It? — Risk Factors
Older age (mostly 70+), osteoporosis (especially undiagnosed/untreated), falls (most common mechanism), female sex, prior fragility fracture, low BMI, sarcopenia, vision/hearing impairment, polypharmacy (anticholinergics, sedatives, antihypertensives), orthostatic hypotension, dementia, Parkinson's disease, stroke, frailty, vitamin D deficiency, alcohol ≥3/day, smoking, glucocorticoids, aromatase inhibitor / ADT survivorship, CKD-mineral bone disease.
PrimerThe Numbers — Mortality, Trajectory, Recovery
~300,000 US hip fractures/year; growing with aging population. One-year mortality 20–30% in real-world cohorts (worse with older age, male sex, dementia, frailty). 50% don't return to prior functional level at one year. 25% lose independence and enter long-term care. ASA score, baseline functional status (ADLs/IADLs/ambulation), comorbidities, anticoagulation drive perioperative risk. The good news: geriatric co-management + same-day surgery + early mobilization + secondary fracture prevention substantially improve outcomes.
PrimerRecognition + ED Pathway
Pain at hip, groin, or thigh after a fall + inability to bear weight = ED, even with minor mechanism. Leg shortened and externally rotated = classic displaced femoral neck. Do NOT try to walk on it. Pre-hospital: pain management, expedite transport. In the ED: standard pre-op workup (CBC, BMP, coagulation, ECG, type-and-screen, anticoagulation review). Imaging: AP pelvis + lateral hip X-ray; if X-ray negative but clinical suspicion high → MRI for occult fracture.
Learn ItSurgical Pathway — Same-Day Is Best
Same-day or next-day surgery is associated with lower mortality and better outcomes than delay. Choice of operation depends on fracture pattern and patient factors: hemiarthroplasty or total hip arthroplasty for displaced femoral neck; intramedullary nail or sliding hip screw for intertrochanteric; THA gives better functional outcomes than hemiarthroplasty in active patients. Spinal vs general anesthesia — comparable mortality; choice individualized. Anticoagulation reversed/held per protocol. Geriatric co-management improves outcomes.
Learn ItKnow My Numbers
ASA score (anesthetic risk) · baseline functional status (ADLs, IADLs, ambulation, gait speed) · comorbidities · anticoagulation · bone density (T-score) · FRAX · cognition baseline (MoCA — sets the delirium-risk dial) · medication audit (anticholinergics, sedatives, antihypertensives, fall-risk meds, anticoagulation) · vitamin D + albumin + protein adequacy (recovery substrate) · weight / BMI · orthostatic BPs (cause-of-fall workup). Bring a one-page numbers card or assist your Ambassador in building one.
Learn ItLifestyle Force Field — Recovery + Prevention
Post-op recovery + secondary prevention: early mobilization within 24 hours (PT-guided weight-bearing progression — most surgeries permit weight-bearing as tolerated immediately), protein 1.2–1.5 g/kg/day (recovery substrate; older adults often protein-undernourished), calcium 1,000–1,200 mg/day from food first + vitamin D 800–1,000 IU, fall prevention (home sweep, footwear, vision, hearing, med review — RRPS bridge), resistance + balance training during and after rehab, social engagement (depression risk is high; treating mood is recovery work), sleep, smoking cessation (impairs fracture healing).
Learn ItMedications + Therapies — All Levers
Post-op anticoagulation (enoxaparin, apixaban, rivaroxaban; timing per protocol). Pain management balance: multimodal (acetaminophen scheduled + opioids sparingly + nerve blocks) to avoid delirium — opioids and benzodiazepines drive delirium especially in dementia overlap. Bone-health initiation post-op: do NOT delay anti-resorptive (zoledronic acid IV in-hospital is reasonable; alendronate or denosumab post-discharge). Audit polypharmacy (anticholinergics, sedatives, antihypertensives → fall risk). Continence + mood watch. Stool softeners (opioids cause constipation).
Live ItCare Team Members
Orthopedic Surgery · Geriatric Medicine (co-management improves outcomes) · Hospitalist / PCP · Anesthesiology · PT (early + during rehab + community PT) · OT (ADL recovery, home safety, adaptive equipment) · Pharmacist (polypharmacy + delirium-risk meds + bone-health initiation) · Social Work (SNF / IRF placement; insurance navigation) · Behavioral Health (post-fracture depression is real) · Nutritionist (protein adequacy; vitamin D) · Wound care if needed · BHOF peer (post-recovery, secondary prevention) · Family Ambassador.
Live ItTelemedicine & Tech
Telehealth follow-up for ortho + geriatrics + PT is well-suited to recovery. Activity trackers with step-count and distance (recovery milestones). Fall-detection wearables (Apple Watch fall detection, Life Alert, Kanega) — high-leverage after a hip fracture given second-fall risk. Medication reminders for anticoagulation + bone medication. Home BP cuff for orthostatic monitoring (postural hypotension is a common cause of the original fall). Personal health record for hospital + SNF + IRF + community-PT records. Photo your op note + post-op X-rays for any new clinician.
TechInsurance, SNF/IRF Placement, Cost
Hip-fracture surgery is well-covered by Medicare Part A (inpatient) + Part B (surgeon fee). SNF coverage: Medicare Part A covers 100 days of SNF after a qualifying 3-night hospital stay (varies by plan; Medicare Advantage rules differ). IRF (inpatient rehab facility) requires ability to tolerate 3 hours/day of therapy. Home health covers community-PT + nursing. BHOF Helpline 1-800-231-4222 for bone-health navigation. Manufacturer copay programs for anabolics if osteoporosis is severe. Audit polypharmacy for cost + safety.
Live ItEquity, Access & Cultural Competence
AA hip fracture rates are LOWER than white but mortality is HIGHER — driven by access to orthopedics + geriatrics co-management, post-discharge resources, and secondary-prevention bone-health care. Rural patients face access gaps to high-volume hip-fracture centers (volume matters for outcomes) and to inpatient rehab. Low-income patients have placement disparities — Medicaid SNF placement is harder. LGBTQ+ older adults may face discrimination in SNF/IRF placement. Men are massively undertreated for secondary fracture prevention even after hip fracture (<20% start bone medication). Don't be preachy — be specific.
Share ItTalk to Kids, Partner, Employer
Kids (especially adult children): "Mom/Dad broke a hip. Surgery was within 24 hours. Now the recovery trajectory matters more than the surgery — early mobilization, PT, protein, bone medication so this doesn't happen again. The next 6 weeks decide whether they go home or to long-term care." Partner: surgery-to-home continuum navigator + delirium-watch + adherence partner + post-fracture-treatment-gap rescuer. Family history of hip fracture doubles your fracture risk — tell adult siblings. Employer: FMLA covers surgery + IRF; ADA accommodations for mobility limits on return.
Share ItMentor & Share Insights
BHOF peer-mentor program (post-fracture recovery focus). NOF Generations of Strength. International Osteoporosis Foundation. RRPS Certification (5 of 16 cards falls-themed) for community fall-prevention work. The newly-injured person who hears "I had a hip fracture 18 months ago, did 4 weeks IRF + 12 weeks home PT, I'm on denosumab, I walk a mile a day with a cane, I haven't fallen again" gets a different orientation than statistics. The Ambassador role for post-fracture treatment-gap rescue is the single highest-leverage public-health task here.
Share ItJoin the ROI Study (PHIT)
PHIT — Population Health Impact Tracking. Pairs hip-fracture outcome tracking with cost data — time-to-surgery, geriatric co-management uptake, delirium incidence, length of stay, SNF vs IRF vs home placement, 30/90/365-day mortality, return to prior functional level, post-fracture treatment-initiation rate (HEDIS measure), 2nd-fracture rate, ED visits. Aggregate & anonymous. Cross-references the National Hip Fracture Database (US/UK registries) and the AGS CoCare: Ortho co-management model.
Study🩺 Hand-off to my Hip-Fracture Care Team
Print and bring to your next visit or to SNF / IRF / home. This page tells your team what you have prepared for, what you want to focus on, and how you would like to participate as an active member of your own care team.
- I am a Prepared Patient in training for hip fracture. I have reviewed all 16 squares of this Force Field Fact Sheet.
- I have started building my Health Passport, my op note + post-op X-ray photos, my medication list with anticoagulation, my weight-bearing status, my delirium-prevention plan, my pain-management plan, my baseline functional status, my bone-health workup status (T-score, FRAX, vitamin D — was it ordered before discharge?), and my fall log to bring to every transition.
- I want to teach back what I have learned and have you correct anything I have misunderstood — especially around my weight-bearing status, my anticoagulation, my delirium-prevention plan, my pain-management plan, my bone-health initiation (don't let me leave the hospital without it), when to call vs go to ED, and the next-fracture prevention plan.
What helps my visit
Two minutes for me to teach back. One question I prepared. My latest weight-bearing status. Medication list. Delirium-prevention plan. Pain-management plan. Op note. Confirm my bone-health plan was initiated BEFORE discharge (close the post-fracture treatment gap). Confirm my next PT / OT / ortho / geriatrics appointments are scheduled.
What I am working on
Early mobilization within 24 hours · weight-bearing progression as tolerated · DVT prophylaxis · delirium-prevention protocol · multimodal pain control · protein 1.2–1.5 g/kg/day · vitamin D + calcium · bone-health medication initiation · fall-prevention sweep at home · RRPS Certification bridge for secondary prevention · BHOF peer connection · family Ambassador partnership.
How I want to participate
Shared decisions. Honest conversation about surgical options (THA vs hemi vs ORIF), anesthetic options (spinal vs general), SNF vs IRF vs home recovery, bone-health initiation timing. AHRQ SHARE Approach. PT/OT referral immediately. Coordinate with Geriatric Medicine if available. Don't let me leave the hospital without a bone-health plan and an ortho-geriatrics follow-up appointment.
🔬 Help Prove This Works — Join the FFH ROI & PHIT Study
The Prepared Patient program is being studied to see whether better preparation actually improves outcomes — earlier-to-surgery, more geriatric co-management uptake, less delirium, shorter length of stay, better placement matching (right level of rehab), higher return to prior functional level, fewer 30/90/365-day deaths, closing the post-fracture treatment gap, fewer second fractures — for hip-fracture patients and families. Your participation is voluntary, your data is aggregated and anonymized, and you can withdraw at any time. We also encourage parallel enrollment in the National Hip Fracture Database and the AGS CoCare: Ortho registry where relevant.
➕ Add-On Force Field Card · Hip-Fracture Skill Mastery
If your care plan adds a specific skill or device, bolt on a 5-step Add-On Card. For hip fracture common bolt-ons include: weight-bearing progression routine (PT-guided), DVT-prophylaxis schedule, delirium-prevention protocol (reorientation + sleep hygiene + minimizing tethers + minimizing sedatives + family presence), multimodal pain-management routine (acetaminophen scheduled + opioid sparingly + nerve block), protein-adequate nutrition routine (1.2–1.5 g/kg/day), bone-health medication initiation BEFORE discharge (post-fracture treatment-gap rescue), fall-prevention sweep at home, SNF / IRF / home decision-making checklist, family-Ambassador delirium-watch + adherence + appointment-partner role, secondary-prevention bone-health follow-up routine, RRPS Fall-Prevention Certification bridge, advance care planning.
Introduce
What it is, why it matters, what it does
Coach
Watch a demo + walk-through
Practice
Do it with a coach watching
Train
Use it daily with a check-in
Test
Demonstrate competence + earn badge
Ready to go deeper?
The Prepared Patient · Hip Fracture course turns this fact sheet into a guided journey: pre/post knowledge checks, the recognition-and-ED module, the surgical-pathway module, the geriatric-co-management evidence base, delirium prevention (especially with dementia overlap), the recovery-trajectory module (home / SNF / IRF), pain management balance, the post-fracture treatment-gap rescue (second-fracture prevention with bisphosphonate / denosumab / anabolic), the falls-cascade bridge into RRPS / Osteoporosis upstream layers, the family Ambassador role across the surgery-to-home continuum, the AA mortality disparity story, and your printable Health Passport. Earn Aware → Active → Certified.