Anaesthesia for fractured neck of femur

Mortality following surgery for fractured neck of femur has remained unchanged for many years. Some factors associated with mortality such as increasing age, poor preoperative mobility and dementia cannot be improved by the anaesthetist; however, other factors such as correction of dehydration and hypovolaemia or optimization of treatment for co-existing disease can. Most surgeons believe that surgery within the first 24 hours after injury improves outcome. There is evidence that delaying surgery for up to 3 days after the injury to allow aggressive preoperative management of the patient is more appropriate. Evidence supporting practice guidelines is weak. The consensus opinion regarding current best practice is that meticulous preoperative preparation, choice of anaesthesia to suit the patient's needs, enforced perioperative nutrition and hydration, adequate pre- and postoperative analgesia, early mobilization and thromboprophylaxis will all contribute to a good outcome for the patient. © 2006 Elsevier Ltd. All rights reserved.