References
Management of an isolated neck-of-femur fracture in an elderly patient
Abstract
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.
Femoral neck fractures are one of the most common limb injuries encountered in the pre-hospital setting and affect up to 75 000 elderly people each year (British Orthopaedic Association, 2007). Despite being a common injury, it should not be underestimated; 10% of people with these fractures die within 1 month and up to a third within 12 months (National Clinical Guideline Centre, 2010).
While the majority of these deaths are attributed to co-morbidities (such as pneumonia), effective management from the start of the injury is likely to reduce mortality. A key component of this management surrounds the pharmacological interventions paramedics can offer, particularly to combat pain and prepare the patient for surgery. This article focuses upon pain management in the pre-hospital setting, specifically related to management of femoral neck fracture. The need for a competent assessment of this injury (including a pain assessment) is recognised but is beyond the remit of this article.
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