Anaesthesia for fractured neck of femur

Fracture of the femoral neck is a common injury in the elderly and many patients have significant comorbidities. Effective management requires a multidisciplinary approach including anaesthetists, geriatricians and orthopaedic surgeons. Strict adherence to clinical practice guidelines such as the American College of Cardiology and American Heart Association (ACC/AHA) may reduce unnecessary cardiac consultations. Although early surgery within 24-48 hours is beneficial, there may be medical conditions that need prior optimization. Both general and neuraxial anaesthesia can be used. Overall, there is no significant difference between them in terms of mortality and most complications including pneumonia and pulmonary embolism, although neuraxial anaesthesia is associated with reduced deep vein thrombosis. Pain management should begin preoperatively and a multimodal approach should be used. Peripheral nerve blocks can provide effective analgesia.