跳至主要内容

Surgical Management of Fracture Neck of Femur in a Medically Unfit ASA3/4 Patient Selection Using Direct Infiltration Local Anaesthesia

Read  full  paper  at:
http://www.scirp.org/journal/PaperInformation.aspx?PaperID=48638#.VK37cMnQrzE

ABSTRACT
Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia; that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty); twenty-three procedures were completed (82.14%); no patient required conversion to another form of anaesthesia either general or spinal; five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.
 
Cite this paper
Kamal, T. , Garg, S. , Elsorafy, K. and Duca, A. (2014) Surgical Management of Fracture Neck of Femur in a Medically Unfit ASA3/4 Patient Selection Using Direct Infiltration Local Anaesthesia. Open Journal of Orthopedics, 4, 195-199. doi: 10.4236/ojo.2014.48032.
 
References
[1]Indelli, P.F., et al. (2005) Regional Anesthesia in Hip Surgery. Clinical Orthopaedics and Related Research, 441, 250-255.
http://dx.doi.org/10.1097/01.blo.0000192355.71966.8e
 
[2]Sorenson, R.M. and Pace, N.L. (1992) Anesthetic Techniques during Surgical Repair of Femoral Neck Fractures. A Meta-Analysis. Anesthesiology, 77, 1095-1104.
http://dx.doi.org/10.1097/00000542-199212000-00009
 
[3]Luger, T.J., et al. (2010) Neuroaxial Versus General Anaesthesia in Geriatric Patients for Hip Fracture Surgery: Does It Matter? Osteoporosis International, 21, S555-S572.
http://dx.doi.org/10.1007/s00198-010-1399-7
 
[4]Urwin, S.C., Parker, M.J. and Griffiths, R. (2000) General Versus Regional Anaesthesia for Hip Fracture Surgery: A Meta-Analysis of Randomized Trials. British Journal of Anaesthesia, 84, 450-455.
http://dx.doi.org/10.1093/oxfordjournals.bja.a013468
 
[5]Parker, M.J., Handoll, H.H. and Griffiths, R. (2001) Anaesthesia for Hip Fracture Surgery in Adults. Cochrane Database of Systematic Reviews, 2001, Article ID: CD000521.
 
[6]Finlayson, B.J. and Underhill, T.J. (1988) Femoral Nerve Block for Analgesia in Fractures of the Femoral Neck. Archives of Emergency Medicine, 5, 173-176.
http://dx.doi.org/10.1136/emj.5.3.173
 
[7]Howard, C.B., et al. (1983) Forum. Femoral Neck Surgery Using a Local Anaesthetic Technique. Anaesthesia, 38, 993-994.
http://dx.doi.org/10.1111/j.1365-2044.1983.tb12032.x
 
[8]Fletcher, A.K., Rigby, A.S. and Heyes, F.L. (2003) Three-in-One Femoral Nerve Block as Analgesia for Fractured Neck of Femur in the Emergency Department: A Randomized, Controlled Trial. Annals of Emergency Medicine, 41, 227-233.
http://dx.doi.org/10.1067/mem.2003.51
 
[9]McGlone, R., et al. (1987) Femoral Nerve Block in the Initial Management of Femoral Shaft Fractures. Annals of Emergency Medicine, 4, 163-168.
http://dx.doi.org/10.1136/emj.4.3.163
 
[10]Berry, F.R. (1977) Analgesia in Patients with Fractured Shaft of Femur. Anaesthesia, 32, 576-577.
http://dx.doi.org/10.1111/j.1365-2044.1977.tb10009.x
 
[11]Haddad, F.S. and Williams, R.L. (1995) Femoral Nerve Block in Extracapsular Femoral Neck Fractures. Journal of Bone and Joint Surgery, 77, 922-923.
 
[12]Vloka, J.D., et al. (1999) Anatomical Landmarks for Femoral Nerve Block: A Comparison of Four Needle Insertion Sites. Anesthesia Analgesia, 89, 1467-1470.
 
[13]McAuliffe, N. and Harmon, D. (2009) Ultra-sound-Guided Hematoma Block in Fractured Neck of Femur. Regional Anesthesia and Pain Medicine, 34, 80-81.
http://dx.doi.org/10.1097/AAP.0b013e3181933ff9
 
[14]Sher, D. and Biant, L.C. (2007) Subcapital Fracture of the Femoral Neck in Medically Unwell Patients: Technique for Fixation Using Direct Infiltration Local Anaesthetic Rather than Regional Blockade. Injury, 38, 1209-1213.
http://dx.doi.org/10.1016/j.injury.2007.04.024
 
[15]Augustine, R.W., Macausland Jr., W.R. and Greenwald, W.F. (1955) Local Infiltration Anaesthesia for Knee-Joint Surgery. Journal of Bone and Joint Surgery, 37, 855-858.
 
[16]Scott, N.B. (2010) Wound Infiltration for Surgery. Anaesthesia, 65, 67-75.
http://dx.doi.org/10.1111/j.1365-2044.2010.06241.x
 
[17]Brower, M.C. and Johnson, M.E. (2003) Adverse Effects of Local Anaesthetic Infiltration on Wound Healing. Regional Anesthesia and Pain Medicine, 28, 233-240.
http://dx.doi.org/10.1097/00115550-200305000-00011                                                    eww150108lx
标签：

评论

发表评论

此博客中的热门博文

Does Immigration Promote the Investment of the Monopolistic Firm?

In the present paper, we examine the effect of increasing uncertainty of immigrants’ growth on the optimal timing of investment of a firm that has a monopolistic power over the labor market. It is revealed that when the uncertainty of immigrants’ growth is more than a threshold level, increasing uncertainty of immigrants’ growth accelerates the optimal timing of firms’ investment and enhances the economic growth, even if the uncertainty of immigrants’ growth is formulated by the geometric Brownian motion, which is in sharp contrast to the standard result that an increase in the uncertainty postpones the optimal timing. With an increase in the immigrants over the past ten years, workforces in the host countries have been growing significantly to the extent that the immigrants represent 70% of the increase in the workforce in Europe, and 47% in the United States as OECD indicates. In the present paper, we attempted to investigate the effect of increased uncertainty caused by the growi...
发表评论
阅读全文

Education Policy Implementation: A Mechanism for Enhancing Primary Education Development in Zanzibar

Education is one of the fundamental rights of individuals; therefore, the government of a country needs to develop and strengthen educational policy and quality as well as to ensure that everyone has equal access to basic education. The improvement of access and quality of education in the world is becoming as an essential factor in development, whereas the basic education (primary school), is acknowledged as a foundation of the higher educational development for every country. To fulfill this goal, governments introduce several policies and procedures; however, it requires some reforms and participation from the politician, policymakers, and other stakeholders to re-examine educational policy so that it can lead to multiplication and betterment of the reforms. Educational reforms actually focus on accountability. A positive educational development and reform is very challenging and needs more effort and strategy on how to use and utilize the resources effectively as such it can achie...
发表评论
阅读全文