Management of an isolated neck-of-femur fracture in an elderly patient

Femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered in a step-wise approach and should be progressive to the patients' needs. Pain relief should be sought through the variety of options open to paramedics and should be initiated immediately. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive adequate analgesia and fluid replacement before any definitive treatment at hospital.