Hip fracture in an elderly parent: what to do in the first 48 hours

Most hip fractures happen in ordinary places, to people who were walking a minute earlier. Here is what a family can do in the first hours, and what usually comes after.

Most hip fractures in older people happen in ordinary places. A wet bathroom floor, the last step of a staircase, a rug that slides when you catch its edge. One moment your mother is walking, the next she is on the floor holding her hip and cannot get up.

A hip fracture (kulhe ki haddi tootna, in Hindi) is a break in the top of the thigh bone, close to where it meets the pelvis. If this is happening to someone in your family right now, the short version is: keep them still, call for help, and get them to a hospital with an orthopaedic team. The rest of this article explains the reasons, so that when the doctor starts talking about surgery and anaesthesia you are not hearing it all for the first time.

The short version

In older people a hip fracture usually follows a simple fall, because bones thin out with age (osteoporosis).
Do not try to stand the person up. Keep them still and call for emergency help.
Current orthopaedic guidelines recommend surgery within 24 to 48 hours for most patients, once they are medically fit for it.
Physiotherapy normally starts the day after surgery. Walking again is the goal from the first day.
A hip fracture is also a warning about bone health. Treating that afterwards matters as much as the operation.

How do you know it might be a hip fracture?

Pain is the main sign. It can sit in the hip itself, but just as often in the groin or the buttock, and it gets worse when the person tries to move or lift the leg. Many cannot put any weight on that side. The injured leg may look shorter than the other, and the foot may roll outwards.

Not every hip fracture looks dramatic, though. Some breaks are stable, and a person may manage a few painful steps. So if an older person has had a fall and now has groin or hip pain when they walk, treat it as a fracture until an X-ray says otherwise. Waiting a day or two to see whether it settles is a mistake, because a stable crack can shift and become a much bigger problem.

What to do right after the fall

Don't pull them up. Standing someone with a broken hip can make the break worse and the pain unbearable. Let them stay where they are, even on the floor, if that is where they are most comfortable.
Call for help straight away. Phone the hospital or an ambulance and say it plainly: elderly person, fall, suspected hip fracture, cannot stand. At Maheshwari Hospital the emergency number is +91 93117 48110.
Keep them warm. A blanket under them and one over them. Floors are cold, and older people lose body heat faster than the rest of us.
Ask before giving food or water. If it is a fracture, surgery may be planned within hours and anaesthesia needs an empty stomach. Whether a sip of water is fine is a question for the doctor on the phone.
Collect the papers while you wait. A list of every medicine they take (blood thinners and diabetes tablets matter a great deal), old reports, any heart history or ECG, and the insurance or TPA card if there is one. The surgical and anaesthesia teams will ask for all of it.

Why doctors push for surgery within 48 hours

Most hip fractures in older adults are treated with surgery. The American Academy of Orthopaedic Surgeons updated its guideline in 2021 and recommends operating within 24 to 48 hours for patients aged 55 and over, where the hospital can manage it (AAOS). The reasoning is about what lying in bed does to an older body. Bedsores, blood clots in the legs, chest infections and confusion all become more likely the longer someone stays flat, and rehabilitation gets harder with every day lost (OrthoInfo).

To be straight about the evidence: studies disagree on whether operating earlier saves lives on its own. What most of them do agree on is that earlier surgery goes with shorter hospital stays, fewer pressure sores and a better chance of getting back to independent living. So this is not really a race against a clock. It is about getting the person moving again as safely and as soon as possible.

A delay of a day or so is not always a bad sign. High blood sugar, uncontrolled blood pressure, a recent heart problem or blood-thinning tablets may need to be sorted out first. A good team will tell you what is holding things up and when it will be done. If nobody has told you, ask.

“She is 85. Is it safe to operate?”

It is the question almost every family asks, and it deserves a straight answer. Surgery at 85 carries real risks, and the anaesthetist will check the heart, lungs, kidneys and sugar levels before deciding how to go about it. But age on its own is not what decides. For most older patients the alternative, weeks of bed rest, is the riskier option, and AAOS notes that long bed rest in very old patients can bring on disorientation and make rehabilitation harder. There are people for whom surgery is genuinely too risky. Those are decided one patient at a time, by the doctors who have examined them.

What kind of surgery will it be?

It depends on exactly where the bone has broken, how far the pieces have moved, and the patient's age and how active they were. Your surgeon will explain after the X-ray, but the broad idea is one of two things.

Fixing the bone. When the break is in the sturdier part of the bone just below the ball of the joint, surgeons usually hold it together with screws, a plate, or a metal rod (a nail) that runs inside the bone.
Replacing part of the joint. When the break is right at the narrow neck of the thigh bone and the pieces have moved apart, the blood supply to the ball can be damaged. In older patients the ball is often replaced (hemiarthroplasty), and sometimes the whole joint (total hip replacement).

During either kind of operation, a C-arm, which is a moving X-ray machine, lets the surgeon check the position of the screws or nail on a screen as they work. Our operation theatre has a C-arm machine, and you can read more about our orthopaedics and fracture care on the department page.

What recovery looks like

In most hospitals the physiotherapist visits the day after surgery and gets the patient sitting up, then standing, then taking a few steps with a walker, as NHS hospital leaflets describe (example). That early start is the whole point of operating quickly, and it is not cruelty. Whether the patient may put full weight on the leg or must go slowly depends on the type of fixation and the quality of the bone, so follow the surgeon's instructions and not a neighbour's advice.

Expect to go home with a walker or crutches, to carry on with physiotherapy at home or as an outpatient, and to take pain medicine that is reduced gradually over a few weeks. Nobody can honestly promise a date for "back to normal". It depends on how well the person walked before the fall, their strength, how well they are eating, and how regularly the exercises get done. That last one is the part a family can control.

As per doctors advice, we followed all post surgery care and physiotherapy. She recovered well. She is back to her normal self now.
Harjeet K, whose 82-year-old mother-in-law had a thigh fracture operated at Maheshwari Hospital (patient review)

That was one family's experience of a thigh fracture, not a promise about every case. Recovery differs from person to person. Our physiotherapy department takes patients through exercise programmes after orthopaedic surgery.

The part most families skip: bone health

A hip fracture from a simple fall usually means the bones were already thin. Doctors call it a fragility fracture, and guidance from the American Society for Bone and Mineral Research says it should lead to osteoporosis treatment, not only a bone density scan (summary). The reason is that the risk of a second fracture is highest in the first year or two after the first. Studies from the US show that only a minority of hip fracture patients are actually started on treatment afterwards. We could not find reliable Indian figures. A 2025 review noted that India has no registry for these fractures. It is worth asking either way.

Before you leave the hospital, put these to the orthopaedic surgeon or physician:

Does she need a bone density (DEXA) scan?
Should we check vitamin D and calcium levels?
Does she need medicine for osteoporosis, and who will follow it up?

Please do not start high-dose supplements on your own. Do eat for your bones: milk, curd, paneer, ragi (nachni), sesame and leafy greens all carry calcium.

Preventing the next fall

The CDC's STEADI programme, which doctors use to screen older adults for fall risk, comes back to the same few things (CDC STEADI). Most of them cost very little.

Start with the bathroom. Non-slip mats, a grab bar by the toilet and the shower, and a stool for bathing. If squatting is hard, a commode chair or raised toilet seat is worth every rupee.
Light the way at night. A small night lamp between the bedroom and the toilet.
Clear the floor. Loose rugs, trailing wires and high door thresholds all catch feet.
Rethink footwear. Closed, flat, non-slip shoes. Loose chappals and socks on tiled floors are an accident waiting to happen.
Review the medicines. Ask the doctor whether any of them, such as sleeping tablets, some blood pressure medicines or diabetes tablets, could be causing dizziness or low sugar.
Test the eyes regularly. An old prescription or an untreated cataract makes every step less certain.
Build strength and balance. Walking, getting up from a chair without using the hands, tai chi-style programmes. A few supervised sessions with a physiotherapist is a good way to start.

On vitamin D, advice is mixed on whether supplements prevent falls by themselves. The sensible route is to get the level checked and treat it if it is low.

Common questions

Can someone with a broken hip still walk?

Sometimes, yes. Stable or impacted fractures can allow a few painful steps. But hip or groin pain after a fall, especially when putting weight on the leg, needs an X-ray the same day. A stable crack can shift if it is walked on.

What should I do first if an elderly person falls?

Don't pull them up. Keep them still and warm, call the hospital or an ambulance, and say it may be a hip fracture. Gather their medicine list and old reports while you wait.

Is surgery always needed for a hip fracture?

In older adults it almost always is, because it lets the person sit up and walk early. A few exceptions exist, such as some very stable fractures or patients too ill for anaesthesia. The treating doctors decide case by case.

How soon should hip fracture surgery be done?

Orthopaedic guidelines suggest within 24 to 48 hours once the patient is medically fit. Sometimes a short delay is needed to bring blood sugar, blood pressure or other conditions under control first.

Can a hip fracture be prevented?

Not every time, but the risk can come down a lot. Treat osteoporosis, make the home safer, review medicines that cause dizziness, check eyesight, and keep up strength and balance exercises.

We are open 24 hours for emergencies. Call +91 93117 48110 or message us on WhatsApp. If it is not an emergency but you want an elderly relative checked, the same number will fix a time. Maheshwari Hospital is in Sector 23, Rohini.

Sources

This article is general information and not a substitute for medical advice. Every patient is different. In an emergency, call the hospital or an ambulance straight away.