Orthopaedists have long found hip fractures to be a significant source of clinical uncertainty and professional disagreement. For much of the nineteenth century, surgeons were happy to follow Sir Astley Cooper's directive to 'treat the patient and let the fracture go'. Most sufferers were elderly, near the end of their lives and at significant risk from morbid complications. This palliative posture was further justified by a substantial corpus of medical evidence. Any attempt at therapeutic innovation was unwarranted because clinical experience, post-mortem studies and animal experiments indicated that fractures within the hip joint never healed. Yet as there were isolated cases of intra-capsular healing, surgeons such as Nicholas Senn began to contest this evidence. To his consternation, as he tried to demonstrate the possibility of restorative treatments, Senn found the fundamental problem with hip fractures was that the empiricism of current clinical methods created and perpetuated their own therapeutic justifications. © 2009 Elsevier Ltd. All rights reserved.