Orthopedic Trauma Care for Mature Patients

Your parent broke their hip, and you're trying to figure out what happens next.

The surgery, the hardware, and the recovery plan should match who your parent is and what they need to get back to doing. That's different for every patient, and it should be.

A 70-year-old who walks three miles a day gets the same decision-making rigor as a 45-year-old. A 90-year-old who lives on their own and tends a garden gets the same respect. What changes isn't how seriously we take the injury. What changes is the plan itself, because the right plan depends on the person.

MOTUS is one of the longest-standing Level 1 orthopedic trauma practices in Denver, and fracture and injury care is all we do. We treat a high volume of mature patients with hip fractures, pelvic fractures, and other injuries that are common in older adults, and we know this population well.

Your Parent Broke Their Hip. Here's What You Need to Know.

When your parent or grandparent breaks a hip, you're making decisions in the middle of a crisis. You get the phone call from the ER, surgery is being recommended urgently, and there's very little time to process what's happening, let alone figure out what comes next.

Here's what you should know.

Most hip fractures need surgery. Unlike some fractures where skipping the operating room is a real option, hip fractures in older adults almost always need surgical fixation or replacement. The question isn't usually "should we operate?" It's "what type of surgery, and what does a realistic recovery actually look like for my parent?"

Timing matters. Research supports surgery within 24 to 48 hours of the fracture when the patient is medically stable. Delays past 48 hours are linked to higher complication rates, so the goal is to get your parent medically ready and into the operating room before the risks of lying in bed start stacking up.

The surgery depends on the fracture and the patient. Hip fracture surgery generally falls into two categories:

• Fixation uses screws, plates, or nails to hold the broken bone together. We use this when the fracture pattern and blood supply allow the bone to heal in place.

• Replacement (a partial or total hip replacement) is used when the fracture disrupts the blood supply to the femoral head, which means the bone won't heal on its own.

Which one your parent needs depends on where the fracture is, how displaced it is, their bone quality, how active they were before the fall, and their overall medical status. We match the procedure to the patient, not the other way around.

We Match the Surgery to Your Parent, Not the Other Way Around

We treat the person attached to the X-ray, not the X-ray alone. For mature patients, that means every surgical decision starts with who your parent was before the injury and what they need to get back to.

Activity-matched implant selection. If your parent was walking on their own and living independently before the fall, they get different hardware and a different surgical plan than someone who was already using a walker and living in assisted care. Both deserve excellent surgery, but the surgery itself should match their actual life and goals.

The risk-benefit math changes with age. Every surgery carries risk: anesthesia, blood loss, infection, and medical complications. In mature patients, those risks run higher. But we also weigh them against the risk of not operating, which means prolonged bed rest, skin breakdown, pneumonia, blood clots, and functional decline that may not reverse. That math is different for every patient, and we walk through it with you and your family directly.

We don't escalate when it isn't needed. A straightforward fracture doesn't call for the most complex implant available. If your parent walks to the mailbox and back, they don't need the same reconstruction as someone training for a half-marathon. Matching the intervention to your parent's actual daily life means less time in surgery, fewer complications, and a recovery plan they can realistically follow.

Why We Get Your Parent Moving Early

One of the most common ways mature patients lose ground after surgery is through weight-bearing restrictions that last longer than they need to.

At a lot of facilities, the standard instruction after hip fracture surgery is "non-weight-bearing for 6 weeks" or "toe-touch weight-bearing only." Your parent gets told to stay off the leg, and then weeks of bed rest do more damage than the fracture did.

We do it differently. When the fixation is solid and the bone quality supports it, we move weight-bearing forward as soon as we can. Mature patients lose strength and conditioning fast when they're not moving, and every extra day of restriction raises the risk of deconditioning, pneumonia, blood clots, and losing the independence they had before the fall.

That doesn't mean we push your parent past what their body can handle. It means we don't hold them back past what their surgery actually needs. If the fixation is stable and they can tolerate it, we get them up and moving. For many patients, that means bearing weight on the first day after surgery.

What Recovery Actually Looks Like

Your family deserves honest expectations, and hip fracture recovery in older adults isn't a return to normal in two weeks. Here's what the timeline realistically looks like.

Hospital stay: 1 to 3 days. Physical therapy starts in the hospital, usually the day after surgery. The goal is to get your parent sitting up, standing, and taking steps with support before they leave.

Post-hospital care: 1 to 4 weeks. A lot of patients go to a skilled nursing facility or inpatient rehab for a stretch of intensive daily therapy. Some patients who have strong support at home and enough function to manage safely can go directly home with home health physical therapy instead.

Ongoing recovery: 3 to 6 months. Strength, balance, and endurance come back gradually. The first month is the steepest part of the curve, and most patients see their biggest improvement in the first 12 weeks.

What the numbers actually look like:‍ ‍

• 18 to 33% of older adults with hip fractures die within one year, but that's driven by pre-existing medical conditions that the stress of a fracture makes worse, not by the fracture itself.

• About 50% of older adults have some level of functional difficulty after a hip fracture.

• 29% don't get back to their pre-fracture mobility at one year.

Those numbers aren't meant to scare you. They're meant to give you an honest picture so you can plan. Many patients do well, and some get all the way back to their full pre-injury activity level. The best predictor of how your parent will recover isn't the fracture pattern. It's how they were functioning before the fall, their overall medical health, the support system around them, and how early they start moving after surgery.

What If Your Parent Already Has a Hip or Knee Replacement?

A periprosthetic fracture is a break that happens around an existing joint replacement. If your parent already has a hip or knee replacement and then falls and breaks the bone near that implant, it's a different problem than a regular fracture.

These are getting more common because more joint replacements are being done every year and the population is getting older. The bone around an implant is often weaker than normal bone, and the treatment has to deal with both the fracture and whether the existing implant is still stable. Sometimes the joint replacement itself needs to be revised on top of fixing the fracture.

You need a surgeon who understands both fracture fixation and joint replacement mechanics to handle these well. We see periprosthetic fractures regularly, and when a revision is part of the plan, we coordinate with joint replacement specialists to make sure both problems get addressed together.

Three Questions to Ask the Surgeon

If your parent has broken a hip and you're helping make decisions, these are the questions worth asking.

1. What type of surgery are you recommending, and why this approach over the alternatives?

   You don't need a medical degree to understand the reasoning. If the surgeon can't explain why they chose fixation over replacement (or the other way around) in plain language, ask them to clarify.

2. What's the plan for weight-bearing after surgery?

   If the answer is "non-weight-bearing for 6 weeks," ask why. When the fixation is stable and the bone supports it, early weight-bearing is often better for your parent because it protects against the deconditioning that comes from weeks of not moving.

3. What does realistic recovery look like for my parent, given how they were doing before the fall?

   The surgeon should give you an honest answer, not a best-case pitch. Recovery depends on how your parent was functioning before the fracture, what other medical conditions they have, and how much they can participate in rehab.