• Stela Marić, Allegra Robinson, Catherine Vandepitte, and Admir Hadzic.
• 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.
• Reg Anesth Pain Med. 2014 Mar 1;39(2):168-9.

ObjectiveFemoral 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.Case ReportAn 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.ConclusionsFemoral 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.

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