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Genicular nerve and fracture site chemical neurolysis for distal femoral fracture: a case report
  1. Prateek Dhingra1,
  2. Paul G McHardy2,
  3. Richard Jenkinson3 and
  4. Howard Meng2
  1. 1 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  3. 3 Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Howard Meng, Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; howard.meng{at}


Background Distal femur fractures account for approximately 3%–6% of all femoral fractures. Non-operative management may be an attractive option for the elderly with significant perioperative mortality risk. Adequate pain control is a major barrier to non-operative fracture management. Chemical neurolysis has been described for analgesic management of proximal hip fractures, however no description of interventional management of distal femur fracture exists in literature. We describe a case of phenol chemical neurolysis of genicular nerves in addition to injection at the site of fracture to provide effective analgesia for distal femur fracture.

Case presentation A patient in their 90s with a witnessed mechanical fall sustained an intra-articular displaced fracture of the distal right femur shaft with extension into the distal femoral condyle. The patient elected to undergo non-surgical management given the high perioperative mortality risk. Acute pain service was involved and multimodal oral analgesics including opioids were insufficient in managing the patient’s pain. The addition of femoral nerve catheter local anesthetic infusion did not sufficiently improve analgesia. Phenol chemical neurolysis of the superolateral, superomedial, inferomedial genicular nerves and of the fracture site was offered and performed. Resting pain decreased from Numerical Rating Scale 5/10 to 0/10 on postprocedure day 1. This was sustained at the 2-month timepoint.

Conclusions We report the successful use of phenol neurolysis of genicular nerves and the fracture site in an elderly patient with a conservatively managed distal femur fracture. These interventions resulted in improved analgesia and achieved prolonged duration of effect.

  • Pain Management
  • Acute Pain

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  • Contributors PD: drafted the manuscript. PM: assisted in conducting the neurolytic procedure and edited the manuscript. RJ: edited the manuscript. HM: conducted the neurolytic procedure, followed up with the patient, edited the manuscript, and is content guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.