What is the urgent management for an elderly patient with a hip fracture?

• A. Immediate nonoperative management with traction.
• B. Delayed surgery after a few days.
• C. Nonoperative bed rest.
• D. Prompt surgical stabilization within 24-48 hours.

Answer: (C)

Early surgical stabilization within 24–48 hours is the best approach for an elderly hip fracture when there are no medical contraindications. The reason is that prompt fixation or replacement relieves pain quickly and, crucially, enables early mobilization with physical therapy. Immobilization in bed for extended periods markedly increases complications common in older adults—pneumonia, blood clots, pressure ulcers, delirium, and general deconditioning—and also raises mortality risk and length of hospital stay. Nonoperative bed rest or using traction as a bridge to care does not improve outcomes and keeps the patient immobilized, which worsens these complications. Delaying surgery beyond a couple of days similarly prolongs pain and immobility, further increasing risk. The focus, then, is on optimizing the patient medically but proceeding to definitive surgical fixation as soon as safely possible to minimize complications and promote recovery.