Hip fracture repair: an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Hip fracture repair in one minute
What it is: urgent surgery to fix a broken hip with screws, a plate or a nail, or to replace the broken ball.
Who it is for: people, often older adults, who have broken the top of the thigh bone, usually after a fall.
Main risks: confusion, chest infection, blood clots, infection, the fixing failing; death risk is higher in frail people.
Usually: under spinal or general anaesthetic, about 1–2 hours, ideally within 36 hours of admission.
On this page: What is hip fracture repair? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is hip fracture repair?
A hip fracture is a break at the top of the thigh bone (femur), near the hip joint. The treatment depends on where the break is:
- Intracapsular (inside the joint capsule): often a hemiarthroplasty (replacing the ball) or a total hip replacement; some are fixed with screws
- Extracapsular (below the capsule): usually fixed with a sliding hip screw and plate or an intramedullary nail
Surgery aims to let people get up and walk as soon as possible. UK care follows national standards, with input from orthogeriatricians.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- a hip fracture after a fall or injury
- almost all hip fractures, unless someone is too unwell for surgery
The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It is done urgently, ideally on the day of admission or the next day. Before it, you usually have:
- an examination and X-rays
- blood tests, an ECG and sometimes an echo
- pain relief, often a nerve block in A&E
- a review of your medicines, especially blood thinners, as per centre protocol
- a chance to ask questions and give consent, or a best-interests decision if needed
Step by step
1. Getting ready
Team brief and WHO checklist first, including the implant check and confirming the site and side marking. The anaesthetic team and ODP give the anaesthetic (usually spinal or general, with a nerve block, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning and pressure areas, the diathermy plate, warming, and radiation protection if X-ray is used. The scrub practitioner checks implant and instrument trays are complete and sterile, and does the first count. Theatre traffic is kept to a minimum, especially in laminar-flow theatres.
2. Access
For fixation, the patient lies on a traction table and X-ray is used to line up the bone; a cut is made on the side of the thigh. For hemiarthroplasty, the patient lies on their side and a cut is made over the hip.
3. Fixing or replacing
- A. Fracture assessed. The type of fracture is confirmed on X-ray.
- B. Reduction. For fixation, the bone is lined up on the traction table with X-ray.
- C. Fixation. A sliding hip screw and plate or a nail is inserted, size per device and operator.
- D. Or replacement. For some fractures, the ball is replaced (hemiarthroplasty).
4. Finishing
Final X-ray images are saved. The wound is closed in layers. Final counts are confirmed, implant details recorded, and the patient goes to recovery with a full handover, including limb checks (circulation and nerves), as per centre protocol.
Recovery and aftercare
- First day: getting out of bed with physiotherapists, often the day after surgery.
- Orthogeriatric care: review of medicines, bone health, confusion and nutrition.
- Going home: varies; some people need rehabilitation or extra support.
- Falls and bones: falls assessment and bone-strengthening treatment, as per centre protocol.
- Clot prevention: as per centre protocol.
- Follow-up: as per centre protocol.
Call 999 if you have chest pain or sudden breathlessness. Contact your team if you have increasing pain, a cold, numb or very swollen limb, calf pain, fever, or a wound that becomes red, hot or leaky.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- confusion (delirium) after surgery
- chest or urine infection
- blood clots in the legs or lungs
- wound infection
- the fixing failing or the bone not healing
- dislocation after hemiarthroplasty
- heart or kidney problems
- death, especially in frail people
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- traction table and padding
- image intensifier (C-arm) and radiation protection
- sliding hip screw and plate, or nail system, sizes per device and operator
- hemiarthroplasty instruments and implants, sizes per device and operator
- power drill and guide wires
- bone cement if cemented hemiarthroplasty, per device and operator
- closure sutures or clips and dressings
Procedural steps
- Team brief, WHO sign in; side marked; implant check; anaesthesia and block
- Positioning on traction table or lateral; prep and drape; count
- Reduction under X-ray (fixation)
- Guide wire; screw and plate or nail; X-ray check
- Or hemiarthroplasty: neck cut, stem and head
- Final images; closure; counts; implant log; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Implant check. Read back the implant type, side and size before opening, and record it in the implant log.
- Site and side. Check the marking at sign in and again before the cut.
- Counts matter. Swabs, needles, instruments and small implant parts are counted; speak up if one is missing.
- Radiation safety. Wear lead and a dosimeter when X-ray is used, and keep your distance.
- Frail patients. Pad carefully, keep the patient warm and move them gently.
FAQ
Why is surgery done so quickly?
Early surgery helps people get up sooner and reduces complications.
Will I walk again?
Most people walk again; some need more help than before.
Why do I need bone tests?
A hip fracture can be a sign of weak bones (osteoporosis).
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- NICE. Hip fracture: management (CG124). nice.org.uk/guidance/cg124
- National Hip Fracture Database. nhfd.co.uk
- NHS. Hip fracture. nhs.uk/conditions/hip-fracture
- StatPearls (NCBI Bookshelf), search: hip fracture. ncbi.nlm.nih.gov/books
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
