Dislocation of a femur fracture after femoral nerve block.
OBJECTIVE
Femoral nerve block (FNB) is increasingly used as an analgesic modality in patients with femoral fracture both in the emergency department and preoperatively. We describe an occurrence of unexpected dislocation of the fracture after FNB.


METHODS
An FNB was administered to treat pain in a 48-year-old patient with metastatic breast carcinoma and multiple bone metastases. A diagnostic FNB with 20 mL of 0.25% levobupivacaine resulted in analgesia but also in unexpected gross deformity in the proximal right femur. An x-ray revealed a pathologic fracture of the proximal third femur diaphysis, with reduction and angulation of fragments, necessitating urgent surgery.


CONCLUSIONS
Femoral nerve block confers effective analgesia for femur fracture. However, relaxation of the quadriceps femoris muscle may destabilize the fracture because of an unopposed tone of the hamstrings and/or thigh adductors.
From the *Department of Anesthesiology, Intensive Care Medicine, General Hospital Asklepios, Bad Wildungen, Brunnenallee, Germany; and †Department of Anesthesiology, St. Luke's and Roosevelt Hospitals; ‡New York School of Regional Anesthesia; and §College of Physicians and Surgeons Columbia University, New York, NY.
Stela
S
Marić
Allegra
A
Robinson
Catherine
C
Vandepitte
Admir
A
Hadzic
D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D005267:Femoral Nerve / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000209:etiology; D000077554:Levobupivacaine; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D011859:Radiography
D000077554:Levobupivacaine; D002045:Bupivacaine