[1][3] The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has groin pain and is unable to bear weight.

Avascular necrosis of the femoral head occurs frequently (20%) in intracapsular hip fractures, because the blood supply is interrupted.

Nevertheless, the stress of the injury, and a likely surgery, increases the risk of medical illness including heart attack, stroke, and chest infection.

[citation needed] Hip fracture patients are at considerable risk for thromboemoblism, blood clots that dislodge and travel in the bloodstream.

A pulmonary embolism (PE) occurs when clotted blood from a DVT comes loose from the leg veins and passes up to the lungs.

It usually clears completely, but the disorienting experience of pain, immobility, loss of independence, moving to a strange place, surgery, and drugs combine to cause delirium or accentuate pre-existing dementia.

Prolonged immobilization and difficulty moving make it hard to avoid pressure sores on the sacrum and heels of patients with hip fractures.

[citation needed] Elderly individuals are also predisposed to hip fractures due to many factors that can compromise proprioception and balance, including medications, vertigo, stroke, and peripheral neuropathy.

[5][14][15] Displaced fractures of the trochanter or femoral neck will classically cause external rotation and shortening of the leg when the patient is laying supine.

[21][22] An isolated trochanteric fracture involves one of the trochanters without going through the anatomical axis of the femur, and may occur in young individuals due to forceful muscle contraction.

Therefore, identifying why the fall occurred, and implementing treatments or changes, is key to reducing the occurrence of hip fractures.

A recent study has identified a high incidence of undiagnosed cervical spondylotic myelopathy (CSM) amongst patients with a hip fracture.

[34] Intravenous iron is used in some centres to encourage an increase in haemoglobin levels, but it not known whether this makes a significant difference to outcomes that matter to patients.

Aggressive chest physiotherapy is needed to reduce the risk of pneumonia and skilled rehabilitation and nursing to avoid pressure sores and DVT/pulmonary embolism Most people will be bedbound for several months.

Non-operative treatment is now limited to only the most medically unstable or demented patients or those who are nonambulatory at baseline with minimal pain during transfers.

[37] In elderly patients with displaced or intracapsular fractures surgeons may decide to perform a hemiarthroplasty, replacing the broken part of the bone with a metal implant.

[40] The latest evidence suggests that there may be little or no difference between screws and fixed angle plates as internal fixation implants for intracapsular hip fractures in older adults.

Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs.

[citation needed] Subtrochanteric fractures may be treated with an intramedullary nail or a screw-plate construction and may require traction pre-operatively, though this practice is uncommon.

Forty percent of individuals with hip fractures are also diagnosed with dementia or mild cognitive impairment which often results in poorer post-surgical outcomes.

[46] In such cases enhanced rehabilitation and care models have been shown to have limited positive effects in reducing delirium and hospital length of stay.

[48] There is also moderate-certainty evidence that rehabilitation after hip fracture surgery, when delivered by a multidisciplinary team and supervised by an appropriate medical specialist, results in fewer cases of 'poor outcome', like death and deterioration in residential status.

[50][51] Oral supplements with non-protein energy, protein, vitamins and minerals started before or early after surgery may prevent complications during the first year after hip fracture in aged adults; without seemingly effects on mortality.

Implant failure may occur; the metal screws and plate can break, back out, or cut out superiorly and enter the joint.

There are scoring tools available, such as the Nottingham Hip Fracture Score that can provide an estimate of risk based on the factors that are known to place people at higher risk, such as: advanced age; dementia or delirium on admission, anaemia on admission, co-morbidities; not living at home before the fracture; and previous diagnoses of cancer.

[56] Among those affected over the age of 50, approximately 25% die within the next year due to complications such as blood clots (deep venous thrombosis, pulmonary embolism), infections, and pneumonia.

[60] Rates of hip fractures are declining in the United States, possibly due to increased use of bisphosphonates and risk management.

The overwhelming majority of hip fractures occur in white individuals, while blacks and Hispanics have a lower rate of them.

This may be due to their generally greater bone density and also because whites have longer overall lifespan and higher likelihood of reaching an advanced age where the risk of breaking a hip goes up.

Also, older adults sustain hip fractures because of osteoporosis, which is a degenerative disease due to age and decrease in bone mass.