The anaesthetic management of upper femoral fracture

Patients presenting with upper femoral fracture are usually elderly and therefore a significant proportion will have co-existent disease. The insult of a fracture and its subsequent repair pose demands upon the physiological reserve that some of this high risk patient population will be unable to meet without invasively monitored therapy. This is reflected in the high mortality rate for this procedure. The application of evidence-based practice will increase the proportion of this population able to survive the physiological insult and improve their recovery and length of stay. This evidence base encompasses practice specific to hip fracture patients and to high risk patients in general. Much of this evidence base is applied already but the application of all of the evidence in a 'care bundle' approach should lead to significant improvements in outcome. Initially this may appear costly in terms of manpower and resources, but the longer term improvements and subsequent increased independence of patients mean that overall this approach is cost effective as well as best medical practice.