How Is a Hip Fracture Surgically Repaired?

Hip fractures are surgically repaired through internal fixation or hip replacement. If the fractured bone is repairable, surgeons use metal screws or plates to stabilize it. However, extensive ball-and-socket joint damage or severe bone displacement requires hip replacement, which restores joint function using artificial prostheses.

At Total Orthopedics and Sports Medicine, Dr. Charles Ruotolo performs hip repair surgery immediately after a detailed clinical assessment to restore mobility. Besides urgent treatment, he also offers second opinions if a previous surgery fails to relieve pain. During these consultations, he reviews your imaging, surgical records, and implant position to identify the cause of treatment failure and recommend the most appropriate solution. Contact us to book your appointment at our East Meadow location.

How Do Surgeons Fix a Broken Hip?

To fix a broken hip, surgeons either repair the fractured bone with metal hardware (internal fixation) or replace the damaged joint with an artificial implant (hip replacement). Internal fixation is more suitable for younger patients with minimally displaced fractures. In contrast, hip replacement is often recommended when a severe fracture displaces the ball of the hip joint, particularly in older adults. Surgeons also perform this procedure if internal fixation fails to relieve pain, particularly in cases of significant bone displacement or reduced blood supply.

Here’s how surgeons perform both procedures to fix a broken hip:

Internal Fixation

During internal fixation, orthopedic hip doctors first realign the broken pieces of the fractured bone. Then, they hold the bone in the correct position using metal implants. These implants keep the fracture stable while the bone heals and help prevent further shifting during movement. Here are some common implants surgeons may use during internal fixation:

• Cannulated screws
• Sliding hip screw
• Intramedullary nail
• Plates and screws

Hip Replacement

In hip replacement, the damaged portions of the hip joint are replaced with artificial implants made of metal, ceramic, or durable plastic. There are two main types of hip replacement procedures used for hip fractures, including:

• Partial Hip Replacement (Hemiarthroplasty): In this procedure, the surgeon replaces only the damaged femoral head while leaving the natural hip socket intact to restore function.
• Total Hip Replacement: Both the femoral head and the hip socket are replaced with artificial components, especially in active patients with fractures that damage both sides of the hip joint.

What Types of Hip Fractures Commonly Require Surgery?

Femoral neck fractures and intertrochanteric fractures often require surgery, such as internal fixation or total hip replacement. Hip specialists may also recommend surgical treatment for subtrochanteric fractures and acetabular fractures involving the hip socket. Here’s why these fractures commonly require surgical repair:

Femoral Neck Fractures

The blood supply to the femoral head travels through small vessels that wrap around the femoral neck. When a fracture tears these vessels, blood flow to the bone can decrease significantly. Therefore, surgeons often recommend prompt surgical treatment to reduce the risk of avascular necrosis (tissue death). In addition, surgery helps prevent the broken bone pieces from shifting further under the constant forces generated by the hip joint during movement. According to a study published in The Journal of Bone and Joint Surgery, approximately 77% of femoral neck fractures healed successfully after internal fixation.

Intertrochanteric Fractures

Intertrochanteric fractures occur in the upper femur, just below the femoral neck and between the greater and lesser trochanters. These fractures can severely limit mobility, which increases the risk of blood clots, respiratory infections, pressure sores, and other potentially life-threatening complications. To minimize these risks, surgeons often recommend surgical stabilization. After surgery, many patients can begin bearing weight and walking within a few days with the help of assistive devices. Early mobility reduces the risks associated with prolonged bed rest and supports a faster recovery.

Subtrochanteric Fractures

After a subtrochanteric fracture, powerful hip and thigh muscles can pull the broken pieces out of alignment. At the same time, the area must bear significant bending and compressive forces during everyday movement. In addition, the subtrochanteric region contains dense cortical bone, which has a more limited blood supply and typically heals more slowly. All these factors make surgical stabilization necessary to maintain alignment of the fractured bone and reduce the risk of fixation failure or nonunion.

Acetabular Fractures

Without surgical treatment, acetabular fractures may increase the risk of hip osteoarthritis. These fractures damage the smooth articular cartilage that lines the pelvic bone. As cartilage wears away, it can lead to bone-on-bone friction, which may cause chronic hip pain, stiffness, and reduced mobility. Similarly, acetabular fractures may damage the acetabular roof, reducing support for the femoral head. As a result, surgery is often necessary to prevent migration or partial dislocation of the femoral head and restore normal joint stability.

Which Fractures Are Best Treated With ORIF?

Non-displaced or minimally displaced femoral head fractures are often best treated with ORIF (cannulated screws), especially in younger or physically active patients. Similarly, intertrochanteric fractures with intact medial and lateral cortical support may heal properly with ORIF. In many cases, subtrochanteric fractures also require internal fixation with intramedullary rods to reduce the risk of nonunion.

How Does Hip Pinning and Replacement Differ?

Hip pinning uses metal screws that hold the fractured bone together while it heals, preserving the natural femoral head. In contrast, hip replacement involves removing the damaged femoral head and replacing it with an artificial implant. Fixation often requires several weeks of limited or non-weight-bearing. Meanwhile, hip replacement can allow many patients to stand, walk, and place weight on the affected hip within 24 hours after surgery.

In addition, hip pinning generally involves smaller incisions and less bone removal than replacement. It also requires less operating time and may result in lower blood loss. Similarly, hip pinning carries a higher risk of nonunion and avascular necrosis, especially in some femoral neck fractures. While hip replacement does not usually lead to these specific complications, it may still cause implant wear, infection, and implant loosening in some cases.

When Is Hemiarthroplasty Recommended Instead of Fixation?

Our surgeon, Dr. Charles Ruotolo, may recommend hemiarthroplasty instead of fixation for displaced femoral neck fractures, especially in older or less active patients. He may also advise it for patients with osteoporosis, severe medical conditions, or cognitive impairment. In these patients, fixation may fail due to poor blood supply, low bone density, or inability to follow strict postoperative weight-bearing restrictions.

In fact, a PubMed Central study found that hemiarthroplasty had a 1.2% revision rate in patients aged 60 or older. On the other hand, fixation surgery showed a 4% to 14.4% complication rate, depending on the specific fixation method. This means that nearly 98.8% of patients treated with hemiarthroplasty avoided revision surgery, whereas fixation had a higher chance of requiring another procedure.

What is the Most Common Cause of Hip Fractures?

A fall, especially from standing height, is the most common cause of a hip fracture. This injury is more common in older patients with osteoporosis, as weaker bones can break even after minor trauma. However, in younger adults, hip fractures are less common and usually occur after high-impact trauma, such as a car accident or motorcycle collision.

Here are some other factors that can increase the risk of fragility fractures:

• Vision problems: Difficulty seeing obstacles, stairs, or uneven surfaces can contribute to falls and hip injuries.
• Certain medications: Some medications may cause dizziness, drowsiness, or low blood pressure, which can increase fall risk.
• Vitamin D deficiency: Low vitamin D levels can weaken bones and impair muscle function, increasing the risk of fractures.
• Muscle weakness: Weak muscles provide less support around the hip and make it difficult to maintain balance.
• Smoking: Smoking reduces bone density and slows the body’s ability to maintain healthy bone tissue.
• Chronic medical conditions: Conditions such as Parkinson’s disease, stroke, arthritis, and peripheral neuropathy can affect balance, coordination, and walking ability.
• Low body weight: People with low body weight often have less bone mass and cushioning around the hip, which can increase fracture risk after a fall.
• Sedentary lifestyle: Lack of regular movement can weaken bones, reduce muscle strength, and affect balance.

How Long Does Hip Fracture Surgery Usually Take?

Hip fracture surgery usually requires 1 to 4 hours, depending on the type of fracture and the surgical procedure. For example, internal fixation or hip pinning may take 45 minutes to 2 hours. In comparison, a partial hip replacement usually takes 1 to 2 hours, while a total hip replacement may require 1.5 to 3 hours as it involves more complex joint reconstruction.

Here are some other factors that may affect the surgery duration:

• Fracture complexity: Simple fractures are usually easier to repair. However, fractures with multiple broken pieces often require additional time to restore proper alignment.
• Bone quality: Osteoporosis can make it difficult to stabilize the bone. As a result, surgeons may use additional fixation techniques during surgery.
• Soft tissue damage: Damage to nearby muscles, tendons, or other soft tissues may increase the time needed to safely complete the procedure.
• Previous hip surgery: Existing hardware or scar tissue can make surgery more challenging. Therefore, revision procedures often take longer than primary surgeries.
• Patient’s overall health: Certain medical conditions, such as bleeding disorders, may require additional monitoring or surgical precautions, which can extend the total procedure time.
• Need for bone grafting: Some fractures leave gaps or areas of bone loss that require bone graft material. This adds extra surgical steps and can increase procedure time.
• Associated fractures: Some patients experience additional fractures around the pelvis or femur. In such cases, treating multiple injuries during the same operation can increase overall surgical time.

What Follow-Up Care Is Needed After Hip Fracture Repair?

Follow-up care after hip fracture repair focuses on early mobility, wound protection, pain management, and regular imaging reviews. To support mobility, our surgeon, Dr. Charles Ruotolo, usually recommends supervised walking, assistive devices, and targeted exercises. He also provides wound care instructions, including how to change dressings, keep the incision dry, and observe warning signs such as redness, drainage, fever, or worsening pain.

Additionally, our surgeon prescribes pain medications and ice therapy to reduce discomfort and swelling. If opioids are needed for severe pain, he limits them to short-term use. He also develops an opioid reduction plan to gradually lower the dose as your condition improves. Similarly, he provides the following movement instructions to protect the surgical repair:

• Avoid bending your hip past 90 degrees.
• Do not cross your legs while sitting or lying down.
• Use chairs with armrests for better support.
• Avoid low chairs, low toilets, or soft couches during early recovery.
• Sleep with a pillow between your knees if your surgeon recommends it.
• Avoid sitting for more than 30 to 45 minutes at a time.
• Use handrails when climbing stairs.
• Avoid twisting your hip suddenly while turning.

In addition to these instructions, Dr. Charles Ruotolo schedules regular follow-up consultations to monitor your recovery. During these visits, he reviews X-rays, checks implant position, assesses bone healing, and identifies early signs of complications. Then, he adjusts your weight-bearing status, exercise plan, or medications based on your healing progress.

How Soon Can You Walk After Hip Fracture Surgery?

Based on our experience, most hip fracture patients can begin walking within 24 hours after surgery. In fact, our surgeons encourage early mobility because it improves blood circulation, helps prevent blood clots, and supports a smoother recovery. However, your weight-bearing status depends on the type of surgery.

For example, if you undergo total or partial hip replacement, you can place full weight on the operated leg. Still, you must use a walker to maintain balance and prevent falls. In contrast, if you are treated with internal fixation for complex fractures, you may need to follow partial weight-bearing restrictions as the fractured bone heals. During this period, you can place only some of your body weight on the injured hip and must rely on a walker or crutches for additional support.

Similarly, with unstable fracture patterns or poor bone quality, you may be advised to follow a period of non-weight bearing to protect the surgical repair. In this case, your foot should not touch the ground. Besides walking, you can also begin practicing stair climbing under professional supervision during the first one to six weeks of recovery.

As your walking pattern improves, our surgeon may advise you to walk without support and begin targeted exercises to rebuild strength and balance. Here are some common exercises Dr. Charles Ruotolo may recommend as part of a multidisciplinary care plan to support hip fracture recovery:

Exercise Category	Examples
Range-of-motion exercises	Heel slides, hip abduction movements, and seated knee extensions
Strengthening exercises	Glute squeezes, quadriceps sets, and standing hip extensions
Balance and stability exercises	Weight shifts, supported standing exercises, and single-leg balance progressions
Conditioning exercises	Stationary cycling and low-impact cardiovascular training

How Long Does Recovery Take After Hip Fracture Surgery?

After surgery, hip fracture recovery usually takes 3 to 4 months, although full healing may require up to a year. The exact timeline depends on your age, overall health, type of fracture, and surgical treatment. For example, elderly patients may require a longer recovery and extended hospital stays due to osteoporosis, muscle weakness, and chronic medical conditions. Similarly, certain fractures may require a more prolonged healing period. For example, subtrochanteric fractures often heal more slowly because of high biomechanical stress.

Book an Appointment with Dr. Charles Ruotolo for Hip Fracture Treatment in East Meadow!

A hip fracture is a serious injury that requires immediate medical attention. However, even in an emergency, treatment should begin after a detailed assessment, as fracture pattern, bone quality, and hip joint damage can affect the surgical plan. Without proper assessment, you may receive the wrong type of fracture repair, which increases pain and delays healing.

At Total Orthopedics and Sports Medicine, Dr. Charles Ruotolo, our Castle Connolly Top Doctor, performs a detailed physical examination, reviews your medical history, and orders same-day X-rays to assess the severity of the hip fracture. Based on these findings, he performs the most appropriate surgical treatment using minimally invasive techniques. Contact us or visit 2339 Hempstead Turnpike, East Meadow, for expert orthopedic care.

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