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

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.