Enhanced recovery for neck of femur fracture: a current concept and review of perioperative interventions

Abstract

Neck of femur (NOF) fracture is a common and life threatening injury. Prompt treatment and mobilisation of this cohort of patients will reduce perioperative complications and cut the cost to the health care providers. The current economic environment requires short hospitalisation and early discharge without compromising patient safety. The current concept of enhanced recovery is widely accepted with successful outcomes in elective hip and knee arthroplasty. This can be applied to enhance recovery for neck of femur injuries with the potential to improve outcome and reduce cost. The aim of this review is to actively encourage the use of the individual interventions mentioned below in unison and work towards a unified national enhanced recovery programme for neck of femur fractures. Using a thorough electronic literature review we compiled a list of evidence based interventions that aim to reduce length of stay and encourage early active mobilisation. Pre-operative interventions included pre-operative injury scoring, patient education, facia iliaca block, pre-operative nutritional support, surgery within 24 hours of admission and a liberal transfusion policy. Intra-operative interventions included epidural analgesia and anaesthesia, high concentration Oxygen, optimal fluid management and minimally invasive surgery. Post-operative interventions included wound infection prophylaxis, intensive physiotherapy and early mobilisation, and early discharge planning. We acknowledge that more research is needed in order to adequately assess the benefits of enhanced recovery in neck of femur fractures and hope that this thorough evidence based literature review is the first step needed.