IT/IC Fractures
Intertrochanteric and Intracapsular Hip Fracture Surgery is an orthopaedic procedure that fixes or replaces the fractured hip using metal implants — restoring stability, relieving severe pain, and enabling early mobilisation to prevent the life-threatening complications of prolonged bed rest in elderly patients.
Overview
Intertrochanteric (IT) and Intracapsular (IC) hip fractures are among the most common and serious orthopaedic injuries, occurring predominantly in elderly patients following low-energy falls onto osteoporotic bone. IT fractures occur through the intertrochanteric region of the proximal femur and are typically fixed with a dynamic hip screw (DHS) or an intramedullary nail, while IC fractures involve the femoral neck and are treated with internal fixation in younger patients or hemiarthroplasty/total hip replacement in older patients. Early surgical fixation or replacement is the standard of care — allowing patients to mobilise fully weight-bearing within 24 hours of surgery and preventing the catastrophic complications of prolonged immobility.
Types of Hip Fracture Surgery
The type of surgical intervention for hip fractures depends on the fracture pattern (IT vs IC), displacement, patient age, bone quality, and pre-injury function.
- Dynamic Hip Screw (DHS) Fixation (for stable intertrochanteric fractures)
- Intramedullary Nail Fixation (for unstable intertrochanteric or subtrochanteric fractures)
- Cannulated Screw Fixation (for undisplaced intracapsular fractures in younger patients)
- Hemiarthroplasty (partial hip replacement — for displaced IC fractures in elderly patients)
- Total Hip Arthroplasty (for displaced IC fractures in active, high-demand elderly patients)
Risk Factors for Hip Fractures
Hip fractures occur predominantly in elderly patients with osteoporosis and fall risk factors. Understanding and managing these risks is essential for prevention and for protecting the contralateral hip after fracture.
- Osteoporosis causing fragile, brittle bone that fractures from low-energy falls
- Advancing age with progressive bone density loss and reduced neuromuscular coordination
- Female sex — women have significantly lower bone density after menopause
- Vitamin D deficiency and calcium insufficiency compromising bone mineralisation
- Previous fragility fracture indicating established osteoporosis and high re-fracture risk
- Falls risk from medications (sedatives, antihypertensives), visual impairment, or neurological disease
Hip Fracture Symptoms
Hip fractures present with a recognisable clinical picture that demands urgent orthopaedic assessment and prompt surgical treatment.
- Sudden severe hip or groin pain following a fall or minimal trauma
- Inability to stand or bear weight on the affected leg
- External rotation and shortening of the injured leg compared to the other
- Swelling, bruising, and extreme tenderness around the hip
- Severe pain with any attempt to move the hip passively
- Occasionally — a fracture discovered on X-ray after a patient falls but can still walk (undisplaced)
- Associated injuries from the fall including wrist fractures or head injuries
- Confusion, hypotension, and haemodynamic compromise from blood loss around the fracture
Key Benefits
Discover the advantages of choosing our it/ic fractures services.
Full weight-bearing walking with physiotherapy support from the day after surgery
Prevents all the life-threatening complications of prolonged bed rest in elderly patients
Restores hip stability and eliminates the severe pain caused by the displaced fracture
Early mobilisation dramatically reduces the risk of pneumonia, DVT, and pressure sores
Returns elderly patients to independence and their own home as quickly as safely possible
Clinical Features
The technology, techniques and clinical approach behind our it/ic fractures.
Surgery performed within 36 hours of admission for all medically optimised patients
Orthogeriatric medical team optimises all co-existing conditions before and after surgery
Spinal anaesthesia preferred to reduce anaesthetic risk in elderly patients
Fluoroscopic guidance throughout ensures accurate fracture reduction and implant positioning
Multiple implant options available — DHS, nail, or arthroplasty — matched to fracture type
Preparation Instructions
- Obtain urgent AP and lateral hip X-rays and CT imaging if fracture pattern is unclear
- Provide blood tests including CBC, coagulation, blood group and crossmatch, electrolytes, and kidney function
- Optimise fluid balance, haemoglobin, and electrolytes before surgery
- Assess and manage all co-existing medical conditions — cardiac, renal, respiratory — before surgery
- Stop anticoagulants and antiplatelet agents under haematology guidance with shortest possible delay
- Fast for 6 to 8 hours before surgery — hip fracture surgery should not be delayed more than 36 hours after admission
- Arrange a pressure-relieving mattress and ensure pain management is in place while awaiting surgery
- Arrange post-operative physiotherapy and discharge destination planning (home vs rehabilitation facility) before surgery
The Procedure
Step-by-step guide to what you can expect during your it/ic fractures procedure.
Urgent Hip Fracture Assessment
Your orthopaedic surgeon reviews your AP and lateral hip X-rays and CT scan to classify the fracture as intertrochanteric or intracapsular, assess the fracture displacement and stability, evaluate bone quality on imaging, and select the most appropriate implant — DHS, intramedullary nail, or hemiarthroplasty — for your specific fracture pattern.
Medical Optimisation Before Surgery
Our orthogeriatric team assesses and optimises your cardiac, respiratory, and metabolic function in the hours before surgery. Fluid balance is corrected, haemoglobin optimised, anticoagulants reversed where needed, and all co-existing medical conditions stabilised — because we know that operating on a medically optimised patient produces significantly better outcomes.
General or Spinal Anaesthesia
Spinal anaesthesia is preferred for hip fracture surgery in most patients as it carries a lower risk than general anaesthesia in elderly patients with multiple comorbidities. Our experienced orthopaedic anaesthesiologist selects the safest approach for your individual medical profile and discusses this with you before surgery.
Fluoroscopic Fracture Reduction
Under fluoroscopic X-ray guidance, the fracture fragments are carefully reduced to their normal anatomical position on the fracture table before any implant is inserted. Achieving a good fracture reduction under live imaging before fixation is critical — the quality of the reduction directly determines the quality of the final surgical result.
Implant Insertion and Fluoroscopic Confirmation
The chosen implant — dynamic hip screw, intramedullary nail, or arthroplasty — is inserted through precisely placed incisions under continuous fluoroscopic guidance. Every aspect of implant position is confirmed on multiple X-ray views before the wound is closed to ensure optimal fixation and alignment.
Full Weight-Bearing Mobilisation from Day One
Our physiotherapy team has you sitting at the edge of the bed and standing with support on the day after surgery. Full weight-bearing is permitted from day one for the majority of hip fracture fixation techniques, and our team is committed to getting you walking safely as quickly as possible — because early mobilisation saves lives in elderly hip fracture patients.
What to Expect
Hip Fracture Surgery is performed under general or spinal anaesthesia and takes 1.5 to 2.5 hours. The orthopaedic surgeon uses fluoroscopic X-ray guidance to accurately place a DHS, intramedullary nail, or prosthetic implant through small incisions, fixing the fracture securely or replacing the femoral head to provide immediate stability. You will be sitting up in bed and weight-bearing with physiotherapy support within 24 hours of surgery — this early mobilisation is critically important to prevent pneumonia, blood clots, and pressure sores. Hospital stay is typically 5 to 7 days.
Recovery
After Hip Fracture Surgery, engage fully with physiotherapy from the day after surgery — the earlier and more consistently you mobilise, the better your recovery. Take all prescribed bone protection medications including calcium, vitamin D, and bisphosphonates — these are critical to prevent a fracture of the other hip. Attend all follow-up appointments including X-rays at 6 weeks and 3 months to confirm fracture healing and implant position. Contact your orthopaedic team immediately for increasing hip pain, wound redness or discharge, fever, or inability to bear weight that was previously possible.
Frequently Asked Questions
Common questions about it/ic fractures.
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