Local Anesthesia with Monitored Anesthesia Care for Cephalomedullary Nailing of Proximal Femur Fractures: A Minimally Invasive Approach for High-Risk Surgical Candidates

Background Proximal femur fractures are common orthopedic injuries, particularly in the elderly population, and present significant challenges due to high comorbidity and elevated risk of anesthesia. Traditional management often involves general or spinal anesthesia, which carries a considerable risk of morbidity and mortality in these high-risk patients. This study aimed to evaluate the safety and efficacy of local anesthesia combined with monitored anesthesia care (MAC) as an alternative to general anesthesia in elderly patients with intertrochanteric fractures. Methods In this retrospective study, we included patients aged ≥ 65 years with displaced intertrochanteric fractures who underwent cephalomedullary nailing under local anesthetic infiltration with MAC. Data on demographics, safety outcomes (complications and mortality), and efficacy measures (blood loss, surgical time, anesthesia induction-to-incision time, and length of stay) were collected. Results A total of 35 patients were included, with a mean age of 76.6 years. Major complications occurred in 6 patients (17.1%), with a 90-day mortality rate of 2.8%. The mean blood loss was 108 cc, surgical time averaged 33.6 minutes, anesthesia induction-to-incision time was 6.4 minutes, and the mean length of hospital stay was 2 days. Conclusion Local anesthesia combined with MAC is a safe alternative to general or spinal anesthesia for managing high-risk patients with proximal femur fractures. This approach reduces morbidity and mortality rates while effectively decreasing surgical time and length of hospital stay.