Practice Guidelines

Management of hip fracture in adults: summary of NICE guidance

BMJ 2011; 342 doi: (Published 21 June 2011) Cite this as: BMJ 2011;342:d3304
  1. Saoussen Ftouh, senior research fellow, project manger1,
  2. Antonia Morga, health economist1,
  3. Cameron Swift, emeritus professor of health care of the elderly 2
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2King’s College London School of Medicine, Clinical Age Research Unit, King’s College Hospital, Denmark Hill, London SE5 9RS
  1. Correspondence to: C Swift cameron.swift{at}

Hip fracture resulting from a fall from standing height or lower in people with osteoporosis or osteopenia (fragility fracture) is a major, growing health problem associated with population ageing. It has an annual UK incidence of 70-75 000, with a medical and social care cost of about £2bn (€2.3bn; $3.3bn),1 and one month and one year mortality of about 10% and 30% respectively2 (usually resulting from comorbidity rather than from the fracture itself). A comprehensive multidisciplinary approach, avoidance of delay, and continuity of management are needed from presentation to follow-up, including after transition from hospital back into the community.

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of hip fracture.3 The recommendations are for all adults but are based on surgical, anaesthetic, and orthogeriatric evidence and expertise acquired among older patients (the group in whom hip fracture is most common). Prevention of hip fracture is covered by other NICE guidance (on falls4 and osteoporosis5 6).


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Timing of surgery

  • Perform surgery on the day of, or the day after, admission. [Based on low quality evidence from cohort studies, cost effectiveness evidence, and the experience and opinion of the Guideline Development Group (GDG)]

  • Identify and treat correctable comorbidities immediately to avoid delaying surgery. Such comorbidities may include anaemia, anticoagulation, volume depletion, electrolyte imbalance, uncontrolled diabetes, uncontrolled heart failure, correctable cardiac arrhythmia or ischaemia, acute respiratory infection, and exacerbation of chronic respiratory disorders. [Based on the experience …

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