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
http://www.scirp.org/journal/PaperInformation.aspx?PaperID=48638#.VK37cMnQrzE
Affiliation(s)
Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK.
Department of Trauma, Orthopaedics Leicester Royal Infirmary, Leicester, UK.
Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK.
Department of Trauma, Orthopaedics Leicester Royal Infirmary, Leicester, UK.
Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
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
References
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.
[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 |
评论
发表评论