Surgery Timing in Elderly Hip Fractures: The 24–48-Hour Rule

A hip fracture in an older adult isn’t just a broken bone—it’s an urgent event that affects heart–lung health, independence, and survival. The shared aim across major guidelines is clear: complete essential medical preparation and proceed to surgery within the first 24–48 hours. Early surgery shortens bed time and helps prevent complications while getting patients standing sooner.

What does “early” really mean? In practical terms, it’s same-day or next-day after admission for most patients. During this window the team controls pain, corrects fluids/electrolytes, assesses anemia, and plans clot prevention. The goal isn’t to rush; it’s to prepare quickly and safely so the operation happens on time.

When is a short delay reasonable? If there’s a correctable red flag—such as uncontrolled heart failure, chest infection, severe electrolyte imbalance, or anticoagulation that needs reversing—those issues are addressed promptly and surgery follows without avoidable days of waiting. The principle: fix the fixables, don’t defer unnecessarily.

Pathway to the operating room. Imaging defines the fracture; the plan (fixation or arthroplasty), anesthesia, clot-prevention, and early mobilisation are mapped together. Most patients are helped out of bed on day one with supervised physiotherapy—an important step for safer recovery and fewer complications.

Our approach in Istanbul, Turkey. We keep families informed, minimise waiting, and place the 24–48-hour rule at the centre of care. For patients travelling from other cities or abroad, we coordinate imaging review, admission, surgical timing, and rehabilitation so the focus stays on a confident return to independence.