Pre-hospital immobilisation for neck of femur fractures in Australia - a break in the evidence



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Moore E, Obst S, Heales L, Clift K, Stanton R. Pre-hospital immobilisation for neck of femur fractures in Australia - a break in the evidence. Australasian Journal of Paramedicine [Internet]. 2021Jun.20 [cited 2023Jan.26];18. Available from:


Neck of femur (NOF) fractures present a significant challenge for healthcare systems and are associated with major complications and high mortality. Hospital clinical pathways aim to improve care and optimise outcomes for individuals sustaining NOF fractures; however, these pathways exclude the pre-hospital management of suspected NOF fractures. Therefore, there remains a lack of evidenced-based standardisation for pre-hospital management. To date, research into pre-hospital management of NOF fractures has mostly focussed on pain relief, with very little research examining immobilisation techniques. This is despite immobilisation offering great clinical benefit for other long bone fractures. Unlike hospital clinical pathways that undergo annual reports and reviews, pre-hospital guidelines for NOF fracture immobilisation have received little attention in the past decade. Given advances in research-informed practice for pre-hospital management of other fractures, it seems timely and pertinent to examine current clinical practice guidelines for NOF fractures, focusing on the appropriateness of current immobilisation techniques.


O'Connor R. Prehospital care in isolated neck of femur fracture: a literature review. Journal of Paramedic Practice 2019;11:21-7.

Australian Institute of Health and Welfare. Trends in hospitalised injury due to falls in older people 2007-2008 to 2016-2017. Canberra: AIHW; 2019.

Queensland Health. Fall statistics - stay on your feet 2019. Available at:

Borges FK, Bhandari M, Guerra-Farfan E, et al. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 2020;395:698-708.

Royal College of Physicians. National hip fracture database annual report 2019. London: RCP, 2019. Available at:

Ambulance Victoria. Ambulance Victoria clinical practice guidelines 2017. 2018. p. 1-303. Available at:

NSW Ambulance Protocols [mobile application software] (version 2.1.0). Rozells: NSW Ambulance ICT. Available at: [Accessed 12 January 2021].

Queensland Ambulance Service. Clinical practice guidelines limb injury. Brisbane: Queensland Ambulance Service; 2016. Available at:

Hards M, Brewer A, Bessant G, Lahiri S. Efficacy of prehospital analgesia with fascia iliaca compartment block for femoral bone fractures: a systematic review. Prehosp Disaster Med 2018;33:299-307.

Sprouse RA, McLaughlin AM, Harris GD. Braces and splints for common musculoskeletal conditions. Am Fam Physician 2018;98:570-6.

Katz S, Arish N, Rokach A, Zaltzman Y, Marcus E-L. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med 2018;18:1-16.

Cross D. Comparison of percieved pain with different immobilization techniques. Prehosp Emerg Care 2001;5:270-4.

Lee C, Porter KM. Prehospital management of lower limb fractures. Emerg Med J 2005;22:660.