Subcapital fracture of the femoral neck in medically unwell patients: technique for fixation using direct infiltration local anaesthetic rather than regional blockade.

Abstract

Patients presenting with fracture of the femoral neck are usually elderly, and often have extensive co-morbidity. Patients who are considered able to survive an operation under general or regional anaesthesia usually undergo surgical stabilisation of the fracture or hemiarthroplasty of the hip for pain relief, to facilitate mobilisation and minimise the risk of developing the sequelae of bed rest. Patients who are considered too unwell for surgery are often treated non-operatively. These patients have a high morbidity and mortality and present significant nursing difficulties. We describe a technique for fixation of subcapital fracture of the femoral neck under local anaesthesia direct infiltration only which is suitable for the medically unwell patient who may otherwise be treated non-operatively. A case series of patients on whom it was performed is presented. None of the patients required a supplementary anaesthetic technique, all survived to discharge from hospital. We recommend all patients with a subcapital fracture of the femoral neck are offered surgery to optimise their chance of survival and avoid the morbidity associated with bed rest.