In elderly patients with an acute hip fracture, what is the recommended timing for definitive surgical treatment?

• A. After 2 weeks
• B. Within 24-48 hours
• C. Immediately after admission without anesthesia
• D. Only after delirium resolves

Answer: (B)

Early surgical treatment within the first 24 to 48 hours after admission is preferred for elderly patients with an acute hip fracture. This timing allows the patient to start mobilizing sooner, which helps control pain and reduces complications from being bedbound, such as pneumonia, pressure ulcers, blood clots, and delirium. It also lowers overall mortality and shortens hospital stay. If the patient has significant medical instability, brief optimization is reasonable, but delaying beyond 48 hours generally increases risk rather than improves outcomes. Immediate surgery without proper anesthesia isn’t realistic, and waiting until delirium or other issues completely resolves can lead to worse results, since delirium is often exacerbated by prolonged immobilization and pain.