On this page· 3 sections
  1. 01Surgical Choice According to Fracture Type
  2. 02Timing and Process of Surgery
  3. 03Post‑operative

Hip fracture surgery is performed using two basic surgical strategies according to the anatomical location of the fracture: intramedullary nailing or prosthesis. The goal is to mobilize the patient as soon as possible with full weight‑bearing.

Surgical Choice According to Fracture Type

Trochanteric Fractures → PFNA (Nailing)

In fractures of the trochanteric region of the femur, an intramedullary nail (PFNA) is used: a small incision over the hip is made and the nail is inserted into the bone, with the femoral head fixed to the nail using a spiral screw. Because the bone vascularity is preserved in this area, the healing rate is high.

Femoral Neck (Collum) Fractures

  • In elderly patients → Prosthesis: Because the fracture disrupts the blood supply to the femoral head, fixation carries a risk of nonunion; therefore hemiarthroplasty (partial prosthesis) or, in more active patients, total hip arthroplasty is performed. The patient can bear full weight and walk immediately after surgery.
  • In younger patients → Fixation: The bone is preserved; the fracture is reduced to anatomic alignment and stabilized with screws or specialized plates.

Hip fracture surgery pre- and post-operative evaluation graph

Timing and Process of Surgery

Hip fracture surgery is a life‑saving emergency; after optimizing the patient’s overall condition, it is aimed to be performed within the first 24–48 hours. The operation is usually performed under spinal anesthesia; its duration is 45–90 minutes depending on the procedure.

Femoral neck fracture: direct view of the fracture line on the graph

Post‑operative

  • The patient is mobilized with a walker and begins weight‑bearing within 1–2 days.
  • Hospital stay is 3–5 days; a physical therapy program follows discharge.
  • Osteoporosis treatment and fall‑prevention education must be initiated to prevent secondary fractures.

Frequently Asked Questions

What is PFNA (nailing)?
It is the fixation of the fracture using a special nail placed inside the bone and a spiral screw attached to it; it is the standard method for trochanteric hip fractures. The patient can bear weight and walk 1–2 days after surgery.
Why is a prosthesis preferred in femoral neck fractures?
A femoral neck fracture disrupts blood supply, increasing the risk of nonunion and avascular necrosis of the head; in older patients, a prosthesis eliminates these risks and allows the patient to bear full weight and walk immediately.
What is the difference between hemiarthroplasty and total prosthesis?
In hemiarthroplasty only the femoral head is replaced (for low‑activity elderly patients); in total prosthesis the socket is also replaced (provides better long‑term results for more active patients).
How long does the surgery take?
PFNA nailing takes about 45–60 minutes, prosthesis surgery takes 60–90 minutes. Spinal anesthesia is usually preferred.