A Narrative Review:The role of preoperative POCUS in patients with hip and femur fractures
Main Article Content
Abstract
The application of point-of-care ultrasound (POCUS) in clinical anesthesia practice is becoming well established. In this narrative review, we discuss the perioperative use of POCUS beyond venous access and regional anesthesia techniques in patients scheduled to undergo repair of hip or femur fractures.
POCUS has gained widespread value in the evaluation of various organs and systems including the stomach, lungs and heart due to its simplicity, availability, safety, and capacity to provide important information to clinicians. Hip and femur fractures are relatively common, with a prevalence that increases over age 75. By default, this population is associated with a high rate of comorbidities. Early fixation of these fractures can reduce the risk of complications, shorten hospital stay, and reduce cost. In this scenario, a comprehensive preoperative patient evaluation is not always feasible. Therefore, POCUS emerges as a valuable tool. In this narrative review, the multiples ways that POCUS can be used are explored including the most common findings and it’s implications in clinical practice. Our goal is to show how the application of this technique can guide the management of hip or femur fractures to possibly obtain a better outcome.
Article Details
How to Cite
MGC, Cruvinel,; CM, Wells,.
A Narrative Review:The role of preoperative POCUS in patients with hip and femur fractures.
Medical Research Archives, [S.l.], v. 13, n. 6, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6655>. Date accessed: 15 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6655.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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27. Ko SB. Perioperative stroke: pathophysiology and management. Korean J Anesthesiol. 2018;71 (1):3-11. doi: 10.4097/kjae.2018.71.1.3.
28. Vlisides P, Mashour GA. Perioperative stroke. Can J Anaesth. 2016;63(2):193-204. doi: 10.1007/s
12630-015-0494-9.
29. Fatima H, Amador Y, Walsh DP, et al. Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach Proposal. J Cardiothorac Vasc Anesth. 2021;35(8):2273-2282. doi: 10.1053/j.jvca.2 021.04.009.
30. Grott K, Chauhan S, Sanghavi DK, et al. Atelectasis. [Updated 2024 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK545316/
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32. Smilowitz NR, Banco D, Katz SD, Beckman JA, Berger JS. Association between heart failure and perioperative outcomes in patients undergoing non-cardiac surgery. Eur Heart J Qual Care Clin Outcomes. 2021;7(1):68-75. doi: 10.1093/ehjqcco/q cz066.
33. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001 Jan 4;344 (1):17-22. doi: 10.1056/NEJM200101043440103.
34. Varrias D, Palaiodimos L, Balasubramanian P, et al. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med. 2021; 10(17):3903.08/30/2025. doi: 10.3390/jcm10 173903. PMID: 34501350.
35. Singh K, Carvalho R. Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery. Cureus. 2021;13 (12). 12/20/2021. doi: 10.7759/cureus.20545.
36. Magin JC, Wrobel JR, An X, ey al.. Venous Excess Ultrasound (VExUS Grading to Assess Perioperative Fluid Status for Noncardiac Surgeries: a Prospective Observational Pilot Study. POCUS J. 2023;8(2):223-229. doi: 10.24908/pocus.v8i2.16792.
37. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/ SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 5;150(19): e351-e442. doi: 10.1161/CIR.0000000000001285. Epub 2024 Sep 24. Erratum in: Circulation. 2024 Nov 19;150(21):e466. doi: 10.1161/CIR.00000000 00001298.
2. Harvin JA, Harvin WH, Camp E, et al. Early femur fracture fixation is associated with a reduction in pulmonary complications and hospital charges: a decade of experience with 1,376 diaphyseal femur fractures. J Trauma Acute Care Surg. 2012;73(6): 1442-8; discussion 1448-9. doi:10.1097/TA.0b013 e3182782696.
3. Shelton C, White S. Anaesthesia for hip fracture repair. BJA. 2020; 20(5): 142-149. doi: 10.1016/j.bja e.2020.02.003
4. Uppalapati T, Thornton I. Anesthesia Management of Hip Fracture Surgery in Geriatric Patients: A Review. Cureus. 2024; 25;16(9):e70188. doi: 10.77 59/cureus.70188.
5. Bradley CA, Ma C, Hollon MM. Perioperative Point of Care Ultrasound for Hemodynamic Assessment: A Narrative Review. Seminars in Cardiothoracic and Vascular Anesthesia. 2023;27 (3):208-223. doi:10.1177/10892532231165088
6. Naji A, Chappidi M, Ahmed A, Monga A, Sanders J. Perioperative Point-of-Care Ultrasound Use by Anesthesiologists. Cureus. 2021;24;13(5): e15217. doi: 10.7759/cureus.15217.
7. Meier I, Vogt AP, Meineri M, Kaiser HA, Luedi MM, Braun M. Point-of-care ultrasound in the preoperative setting. Best Pract Res Clin Anaesthesiol. 2020; 34(2):315-324. doi: 10.1016/j.bpa.2020.04.010.
8. Ramsingh D, Bronshteyn YS, Haskins S, Zimmerman J. Perioperative Point-of-Care Ultrasound: From Concept to Application. Anesthesiology. 2020;132(4):908-916. doi: 10.1097/ALN.00000000 00003113.
9. Li, L., Yong, R.J., Kaye, A.D. et al. Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview. Curr Pain Headache Rep. 2020; 24 (20). 03/21/2020. doi: 10.1007/s11916-020-0847-0
10. Nason KS. Acute Intraoperative Pulmonary Aspiration. Thorac Surg Clin. 2015;25(3):301-7. doi: 10.1016/j.thorsurg.2015.04.011.
11. Abdulla S. Pulmonary aspiration in perioperative medicine. Acta Anaesthesiol Belg. 2013;64(1):1-13.
12. Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology. 2023;138(2):132-151.
doi: 10.1097/ALN.0000000000004381.
13. Van de Putte P, Vernieuwe L, Jerjir A, Verschueren L, Tacken M, Perlas A. When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients. Br J Anaesth. 2017;118(3):363-371. doi: 10.1093/bja/aew435.
14. Phillips S, Liang SS, Formaz-Preston A, Stewart PA. High-risk residual gastric content in fasted patients undergoing gastrointestinal endoscopy: a prospective cohort study of prevalence and predictors. Anaesth Intensive Care. 2015;43(6): 728-33. doi: 10.1177/0310057X1504300610.
15. Gastric Ultrasound • Interpretation of findings. Accessed April 28, 2025.
https://www.gastricultrasound.org/en/interpretation/.
16. Yarandi SS, Srinivasan S. Diabetic gastrointestinal motility disorders and the role of enteric nervous system: current status and future directions. Neurogastroenterol Motil. 2014;26(5):611-24.
doi: 10.1111/nmo.12330.
17. Milanesi A, Weinreb JE. Diabetes in the Elderly. [Updated 2020 Sep 25]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK279147/
18. Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. Curr Diab Rep. 2013;13(6):805-13. doi: 10.1007/s11892-013-0425-5.
19. Marrinan S, Emmanuel AV, Burn DJ. Delayed gastric emptying in Parkinson's disease. Mov Disord. 2014;29(1):23-32. doi: 10.1002/mds.25708.
20. Willis AW, Roberts E, Beck JC, et al. Incidence of Parkinson disease in North America. npj Parkinsons Dis. 2022; 8(170). 3/22/2022. doi: 10.1038/s41531-022-00410-y
21. Benzinger P, Rapp K, Maetzler W, et al. Risk for femoral fractures in Parkinson's disease patients with and without severe functional impairment. PLoS One. 2014; 22:9(5):e97073. doi: 10.1371/jour nal.pone.0097073.
22. Hasuo H, Kusunoki H, Kanbara K, et al. Tolerable pain reduces gastric fundal accommodation and gastric motility in healthy subjects: a crossover ultrasonographic study. Biopsychosoc Med. 2017; 11(4). 02/02/2017. doi: 10.1186/s13030-017-0089-5.
23. Bojö L, Cassuto J, Nellgård P. Pain-induced inhibition of gastric motility is mediated by adrenergic and vagal non-adrenergic reflexes in the rat. Acta Physiol Scand. 1992; 146(3):377-83. doi: 10.1111/j.1 748-1716.1992.tb09432.x.
24. FPnotebook. Accessed April 28, 2025. https://mobile.fpnotebook.com/GI/Pharm/MdctnsThtDlyGstrcEmptyng.
25. de Weerd M, Greving JP, Hedblad B, et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010;41(6):1294-7. doi: 10.1161/STROKEAHA.110.581058.
26. Chang WL, Chen PY, Hsu PJ, Lin SK. Validity and Reliability of Point-of-Care Ultrasound for Detecting Moderate- or High-Grade Carotid Atherosclerosis in an Outpatient Department. Diagnostics (Basel). 2023;13(11):1952. 06/02/2023 doi: 10.3390/diagnostics13111952.
27. Ko SB. Perioperative stroke: pathophysiology and management. Korean J Anesthesiol. 2018;71 (1):3-11. doi: 10.4097/kjae.2018.71.1.3.
28. Vlisides P, Mashour GA. Perioperative stroke. Can J Anaesth. 2016;63(2):193-204. doi: 10.1007/s
12630-015-0494-9.
29. Fatima H, Amador Y, Walsh DP, et al. Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach Proposal. J Cardiothorac Vasc Anesth. 2021;35(8):2273-2282. doi: 10.1053/j.jvca.2 021.04.009.
30. Grott K, Chauhan S, Sanghavi DK, et al. Atelectasis. [Updated 2024 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK545316/
31. Silva JM Jr, de Oliveira AM, Nogueira FA, et al. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013; 10(17):R288. doi: 10.1186/c c13151.
32. Smilowitz NR, Banco D, Katz SD, Beckman JA, Berger JS. Association between heart failure and perioperative outcomes in patients undergoing non-cardiac surgery. Eur Heart J Qual Care Clin Outcomes. 2021;7(1):68-75. doi: 10.1093/ehjqcco/q cz066.
33. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001 Jan 4;344 (1):17-22. doi: 10.1056/NEJM200101043440103.
34. Varrias D, Palaiodimos L, Balasubramanian P, et al. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med. 2021; 10(17):3903.08/30/2025. doi: 10.3390/jcm10 173903. PMID: 34501350.
35. Singh K, Carvalho R. Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery. Cureus. 2021;13 (12). 12/20/2021. doi: 10.7759/cureus.20545.
36. Magin JC, Wrobel JR, An X, ey al.. Venous Excess Ultrasound (VExUS Grading to Assess Perioperative Fluid Status for Noncardiac Surgeries: a Prospective Observational Pilot Study. POCUS J. 2023;8(2):223-229. doi: 10.24908/pocus.v8i2.16792.
37. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/ SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 5;150(19): e351-e442. doi: 10.1161/CIR.0000000000001285. Epub 2024 Sep 24. Erratum in: Circulation. 2024 Nov 19;150(21):e466. doi: 10.1161/CIR.00000000 00001298.