Femoral neck fractures

Regarding the clinical management of older patients with fractures of the femoral

neck, the following are recognised targets EXCEPT which one?

a) Surgical fixation should be within 24 hours of admission unless there are clear

reversible medical conditions

b) Patients should be admitted to an appropriate ward area within four hours of

presentation

c) A preoperative electrocardiogram is mandatory

d) Addressing analgesic need is a clinical priority

e) Patients with a normal plain radiograph but a strong clinical suspicion of a fracture

should undergo urgent supplementary imaging (MRI, CT or bone isotope scan)

Answer: a

Explanation

Although the topic of this question may seem suited to a surgical exam, the pivotal role

of the anaesthetist in the pre-assessment and pre-optimisation of these often frail

patients plus their involvement in theatre-list planning means familiarity with this

subject is essential. The National Institute of Health and Clinical Excellence is in the

process of producing a complete guideline of recommended practice for these patients.

Until its publication the recognised standards are those of the British Orthopaedic

Association Standards for Trauma (BOAST). As they stand, the target time for surgical

fixation is 48 hours; however, local protocols may vary and indeed this may be revised

to 24 hours in due course.

Reference

British Orthopaedic Association Standards for Trauma. BOAST 1: Hip fracture in the

older person. British Orthopaedic Association, September 2007. Online at www.boa.ac.

uk/default.aspx?ID=280 (Accessed 30 October 2009)