Background <p>Measuring hand grip strength (HGS) at admission can indicate probable sarcopenia in acute hip fracture and may help predict adverse post-operative outcomes.</p> Aims <p>To assess whether HGS is independently associated with adverse post-operative outcomes and enhances risk prediction when combined with the Nottingham Hip Fracture Score (NHFS).</p> Methods <p>Routinely collected National Hip Fracture Database data were combined with HGS at a single, high-volume orthopaedic trauma centre. Sarcopenia status was categorised per 2019 European Working Group thresholds as non-sarcopenic, probable sarcopenia, or unable to complete assessment. Binary logistic regression models and receiver-operating-characteristic (ROC) curves assessed prognostic value of HGS assessment.</p> Results <p>We analysed data from 282 patients, mean age 83.2 ± 9.2 years; 200 (71%) were women. In univariate analysis, probable sarcopenia (low HGS) was associated with 120-day mortality, 30- and 120-day residential status, prolonged length of stay and post-operative delirium. In multivariate analysis including the NHFS, probable sarcopenia was associated with 120-day mortality, 120-day residential status and post-operative delirium. Combining NHFS and HGS assessment improved discrimination for 120-day mortality (c-statistic 0.79 [95%CI 0.73–0.86]), 30-day residential status (0.85 [95%CI 0.80–0.90]) 120-day residential status (0.89 [95% CI 0.85–0.94]) and post-operative delirium (0.91 [95%CI 0.87–0.94]). Inability to complete HGS assessment was associated with worse prognostic outcomes than low HGS.</p> Discussion <p>Sarcopenia is a useful additional predictor of post-operative outcomes in hip fracture, especially post-operative delirium. Inability to complete HGS assessment may indicate even higher risk.</p> Conclusion <p>HGS is an inexpensive, feasible and quick adjunct to the NHFS. Further research is required to validate a combined NHFS-HGS score.</p>