Diagnosing hip fractures involves a comprehensive evaluation by a medical professional to confirm the presence and extent of the injury. The diagnostic process typically includes the following steps:

1. Medical History and Physical Examination: The diagnostic process begins with a detailed medical history and physical examination. The doctor will inquire about the circumstances of the injury, any underlying conditions such as osteoporosis, and the patient’s overall health. During the physical examination, the doctor will assess the patient’s ability to move the hip and leg, check for signs of swelling, bruising, and deformity, and evaluate the range of motion and pain levels in the affected area.

2. Imaging Studies: Imaging studies are essential for confirming the diagnosis of a hip fracture and determining its location and severity. X-rays are the primary imaging modality used to visualise the bones of the hip and pelvis. They can reveal the presence of a fracture, its type (e.g., femoral neck, intertrochanteric), and any displacement of bone fragments. If the fracture is not clearly visible on X-rays but a hip fracture is still suspected based on clinical symptoms, additional imaging tests such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans may be ordered. MRI is particularly useful for detecting hairline fractures and stress fractures that may not be apparent on X-rays.

3. Bone Scans: In some cases, a bone scan may be used to identify fractures that are not visible on X-rays, especially if the patient has multiple injuries or underlying bone conditions. A bone scan involves injecting a small amount of radioactive material into the bloodstream, which collects in areas of bone damage and is detected by a special camera.

4. Blood Tests: Although blood tests are not typically used to diagnose hip fractures directly, they may be ordered to assess the patient’s overall health and identify any underlying conditions that could affect treatment and recovery. For example, blood tests can check for signs of infection, anaemia, and electrolyte imbalances.

5. Evaluation of Associated Injuries: Given the traumatic nature of hip fractures, especially in elderly patients who may have fallen, it is crucial to evaluate for associated injuries. This includes checking for fractures in other parts of the body, head injuries, and soft tissue damage. Comprehensive assessment ensures that all injuries are identified and managed appropriately.

Once a hip fracture is confirmed, the medical professional will classify the fracture based on its type and severity.

Treatment of hip fractures by a medical professional involves a combination of surgical and non-surgical approaches, tailored to the specific type and severity of the fracture, as well as the overall health and needs of the patient. Here’s an overview of how hip fractures are typically treated:

1. Surgical Treatment

• Internal Fixation: For certain types of hip fractures, such as femoral neck fractures or intertrochanteric fractures, internal fixation may be performed. This procedure involves using metal screws, rods, or plates to stabilise the broken bone. The goal is to align the bone fragments correctly and allow them to heal properly. This method is often preferred for younger patients or those with fractures that have not displaced significantly.
  
• Partial or Total Hip Replacement: In cases where the hip joint is severely damaged or in elderly patients with poor bone quality, a partial or total hip replacement may be recommended. During a partial hip replacement (hemiarthroplasty), only the head of the femur is replaced with a prosthesis. A total hip replacement (arthroplasty) involves replacing both the head of the femur and the acetabulum (the socket in the pelvis) with artificial components. This option is often chosen for patients with pre-existing arthritis or those who are less likely to benefit from internal fixation.
  
• Hemiarthroplasty: This procedure involves replacing the broken part of the femur with a metal prosthesis. It is often used for femoral neck fractures in elderly patients where blood supply to the femoral head is compromised, reducing the chance of healing.
  

2. Non-Surgical Treatment

• Conservative Management: In rare cases where surgery is not an option due to extreme frailty or other severe medical conditions, non-surgical management may be considered. This approach typically includes pain management, bed rest, and physical therapy. The primary goal is to keep the patient comfortable and prevent complications such as pressure sores, deep vein thrombosis, and pneumonia.
  
• Pain Management: Effective pain control is essential for patients with hip fractures, both before and after surgery. Medications such as opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anaesthetics may be used to manage pain and make the patient more comfortable.
  

3. Postoperative Care and Rehabilitation Visual changes in the appearance of the leg are common with hip fractures. The affected leg may appear shorter than the other leg, and there may be an outward rotation, making the foot and knee point outward. These abnormalities occur because the broken bone disrupts the normal alignment and support provided by the femur.

• Early Mobilisation: In rare cases where surgery is not an option due to extreme frailty or other severe medical conditions, non-surgical management may be considered. This approach typically includes pain management, bed rest, and physical therapy. The primary goal is to keep the patient comfortable and prevent complications such as pressure sores, deep vein thrombosis, and pneumonia.
  
• Rehabilitation Programs: Comprehensive rehabilitation programs, often involving physical and occupational therapy, are essential for recovery. These programs aim to help patients regain their independence, improve balance and coordination, and adapt to any limitations resulting from the fracture and surgery.
  
• Nutritional Support: Adequate nutrition is important for bone healing and overall recovery. Nutritional support may include dietary modifications, supplements, and in some cases, assistance from a dietitian to ensure the patient receives the necessary nutrients.
  
• Fall Prevention: Addressing the underlying causes of falls is crucial to prevent future fractures. This may involve home safety assessments, assistive devices such as walkers or canes, and medication reviews to reduce the risk of falls.