When should I consider referring a patient with a hip fracture to orthopaedics?

Consider referring a patient with a hip fracture to orthopaedic specialists immediately upon diagnosis or suspicion of the fracture. Surgery should be performed on the day of, or the day after, admission to hospital to optimise outcomes. Early referral ensures timely surgical intervention and management of correctable comorbidities that might delay surgery, such as anaemia, anticoagulation, or acute chest infections. If hip fracture is suspected but initial X-rays are negative, offer MRI or CT to confirm diagnosis and facilitate referral. Additionally, management of adults with fragility fractures of the femur should occur within a specialist pathway involving orthogeriatricians, which requires orthopaedic specialist input. Referral is also indicated if the patient is older and on a care pathway without routine geriatrician support, in which case an orthogeriatrician, surgical liaison, or perioperative physician should be involved. Prompt referral allows for adequate analgesia, surgical planning, and multidisciplinary rehabilitation planning.