The surgical reduction and fixation of a hip fracture using hardware. The type of fracture, location, fracture pattern, and patient’s medical condition will determine the type of surgery performed.


Hip fractures are breaks in the upper portion of the thigh bone (femur) and are often seen with high impact trauma directly to the hip in younger adults or from a fall to the hip in the geriatric population and those with medical conditions that can affect the integrity of the bone (i.e. osteoporosis, cancer). It is important for your surgeon to determine exactly which type of fracture is present as the treatment is determined by the type of fracture, location, fracture pattern, and patient’s medical condition.

Intramedullary Nail vs. Plate and Screws

Hip fractures that run between the greater trochanter and the lesser trochanter are called “intertrochanteric” hip fractures. This type of fracture is often surgically treated, with the help of intraoperative x-ray, using an intramedullary nail that runs approximately halfway down the center of the femur (the thighbone). It is then fixated using a series of screws across the bone along the length of the nail. Patients can expect to have one or two small incisions about halfway down the upper leg to the outside of the thigh and one slightly larger incision further up the leg at the hip.
If the fracture is located further down the femur below the trochanters, we refer to this as a “subtrochanteric” hip fracture. Again, an intramedullary nail can be used to fix these types of fractures except in this case the nail is longer and spans the length of the femur. The incisions are similar, however the screws used to fix the nail to the femur bone are further down the leg just above the knee. In some cases, your surgeon may determine that the fracture requires the use of a plate and a series of screws rather than an intramedullary nail. This surgery usually requires a larger incision to the outside of the thigh at the level of the hip.

Intramedullary Nail vs. Plate and Screws​

Intramedullary Nail

Intramedullary Nail vs. Plate and Screws​

Plate and Screws

Percutaneous Pinning

If a hip fracture is isolated to the neck of the femur and remains in anatomic alignment, your surgeon may opt to surgically fix the fracture using a percutaneous pinning method. Usually, this is performed using small incisions over the hip joint and with the guidance of intraoperative x-ray and guide instruments a series of screws are placed in a triangular pattern from the outside, or lateral, aspect of the femur up into the femoral head.

Hip ORIFs (open reduction and internal fixation) usually require a stay at the hospital where the goal is to get the patient up and moving shortly after the fracture is surgically repaired. Your surgeon will determine, based on the extent of the fracture and type of surgery implemented, how much weight you are allowed to bear when performing exercises with your physical therapist. While a therapist will work with you very early in the recovery process, it is important to note that this process could take several months to fully regain full strength and mobility. Your surgeon and physical therapist will tailor your formal physical therapy regimen and weight-bearing status to fit your needs and will monitor your progress closely.

Percutaneous Pinning​

Every Patient Matters

Every patient receives an in-depth consultation to devise a treatment plan that is right for their problem. Our specialists prefer non-operative and non-invasive treatments whenever possible, including physical therapy, medications, and/or injections. When we require surgery, we will then use minimally invasive surgical techniques to fix your problem, whether it is fixing a broken bone or repairing a tendon. Our goal is always to get you back to living your life normally as soon as possible.

With proper treatment, Dr. DeNoble can treat and fix even complete tears. He is an expert in the current minimally invasive standard of arthroscopic repair, avoiding the need for large incisions, and ensuring you can get back to your life in tip-top form.

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