Diagnostic Blocks Research Articles

Fluoroscopy Guided Lumbar Facet Joint Block as a Diagnostic Tool in the Evaluation of Chronic Low Back Ache

Acute low back pain is a common cause of pain in the majority of the adult population. Facet joints are a potential source of pain in low back pain (LBP) and its prevalence increases with age. Our case report is about a 34-year-old male patient who came with chief complaints of chronic low back ache, more on the left side, insidious in onset, non-radiating not associated with tingling or numbness. Pain aggravates on walking, sitting to standing posture, and left side movements. His Numerical rating scale (NRS) was 7 and the Verbal rating scale (VRS) was moderate. On palpation patient had left para median tenderness more at L5-S1 area. The Lasegue straight leg raising test and flexion, abduction, external rotation (FABER) were also negative. We decided to proceed with diagnostic block of left L5-S1 facet joint with 1ml 0f 1% lignocaine and our patient had significant pain relief of about 80%.

Current trends in the technical performance of lumbar zygapophyseal joint interventions

ObjectiveTo survey how interventional pain physicians are currently performing lumbar facet interventions, with an emphasis on fellowship training. DesignSurvey Study. MethodsAn online electronic survey disseminated via Research Electronic Data Capture (REDCap) software to current and expired attending physician members of the Spine Intervention Society (SIS). Responses were stratified by fellowship training type: ACGME Pain Medicine (APM), ACGME Sports Medicine (ASM), Interventional Spine and Musculoskeletal Medicine (ISMM), or None. ResultsAs a whole, a majority of respondents indicated on independent questions they require 2 diagnostic medial branch blocks (MBBs) performed with 0.5 ​cc or less of anesthetic to result in at least 75% pain relief before proceeding with a radiofrequency neurotomy (RFN), performed via parallel approach with 18g or larger needle and 10 ​mm active tip and a lesion of at least 80–85° C and 90–119 ​s of duration. Statistically significant differences as stratified by APM vs ISMM fellowship training included: the use of corticosteroids at the time of RFN (43/79 (54.4%) vs 16/63 (25.4%), typically treating 3 segments or more 22/79 (27.8%) vs 7/73 (9.6%), and MBB volume injectate of ≥ 1 ​cc 22/79 (27.8%) vs 7/63 (11.1%) respectively. ConclusionsThere is largely agreement upon the technical performance of lumbar facet interventions by members of SIS. Physicians who completed an APM fellowship were more likely to report using corticosteroids at the time of RFN, using higher anesthetic volumes and treating 3 or more spinal segments.

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Objective: This retrospective study aimed to investigate the clinical efficacy of GON pulsed radiofrequency (PRF) treatment in migraine patients who did not respond adequately to treatment with greater occipital nerve (GON) blockade. Method: Twenty-seven patients with recurrent episodic migraines or chronic migraines were included in the study. GON blockade was performed bilaterally once a week – four times over a one-month duration. PRF treatment was performed once for those patients who did not show an adequate response to GON blockade, and the treatment was directed at the same sites as the GON blockade. The number of migraine attacks in the preceding 30 days, the total number of triptan tablets taken, the average duration of headache and the highest VAS scores at the first, third and sixth-month visits were recorded. Results: The number of severe migraine attacks, total analgesic use and the maximum duration of migraine episodes were recorded in this study. All these parameters showed a significant decrease from the first month after GON PRF treatment as compared to both the baseline as well as to treatment one month after GON block. In addition, this clinical improvement was sustained up to six months after PRF treatment. Conclusion: Our results suggest that GON PRF treatment is a viable treatment approach in the case of migraine patients who do not respond adequately to treatment with GON blockade.

Medico-Surgical Management of the Spastic Equinovarus Foot Deformity in Adults: A Retrospective Series of 622 Patients

Objective: This study aimed to determine the frequency of spastic equinovarus foot (SEF) treatments. Materials and Methods: the medical files of 622 patients treated for SEF were reviewed. Results: SEF resulted from stroke in 66%. The most frequent pattern was equinovarus in 56%, knee recurvatum in 55%, and claw toes in 41%. Patients benefited from surgical treatment in 59%, including neurotomy in 22%, tendon surgery in 12%, and a combined surgery in 25%. Conclusion: Surgery was performed in 59% of the cases. The type of treatment was influenced by the preoperative diagnostic nerve block assessment.

A Systematic Review and Meta-analysis of the Effectiveness of Radiofrequency Neurotomy in Managing Chronic Neck Pain.

Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks. Systematic review and meta-analysis utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, quality assessment of the included studies, conventional and single-arm meta-analysis, and best evidence synthesis. The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency neurotomy as a therapeutic cervical facet joint intervention in managing chronic neck pain. Available literature was included. Methodologic quality assessment of studies was performed from 1996 to September 2021. The level of evidence of effectiveness was determined. Based on the qualitative and quantitative analysis with single-arm meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, with inclusion of one randomized controlled trial (RCT) of 12 patients in the treatment group and eight positive observational studies with inclusion of 589 patients showing positive outcomes with moderate to high clinical applicability, the evidence is levelII in managing neck pain with cervical radiofrequency neurotomy. The evidence for managing cervicogenic headache was levelIII to IV with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 15 patients in the treatment group in a positive RCT and 134 patients in observational studies. An overwhelming majority of the studies produced multiple lesions. There was a paucity of literature and heterogeneity among the available studies. This systematic review and meta-analysis shows levelII evidence with radiofrequency neurotomy on a long-term basis in managing chronic neck pain with levelIII to IV evidence in managing cervicogenic headaches. The online version contains supplementary material available at 10.1007/s40122-022-00455-0.

Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment.

Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.

STRUCTURAL-FUNCTIONAL MODEL OF FORMATION OF CAREER COMPETENCE OF FUTURE MANAGERS

The article highlights one of the aspects of the systemic psychological and pedagogical problem related to the formation of career competence of future managers in the field of education. The expediency of using pedagogical modeling as a method is substantiated. As a result of the analysis of scientific works, generalization of pedagogical experience the structural and functional model of formation of career competence of future managers of education is offered. The designed model is detailed by consistently defined structural components: target, content, technological and diagnostic blocks.The target component reflects the goal to which all the constituent elements of the model are subordinated, and which is realized through a set of defined tasks. The content block of the model reveals the component composition of career competence and includes the content of future managers’ professional training in the field of education. The technological unit reflects a set of organizational and pedagogical conditions that ensure the effectiveness of the model. The content of the stages of career competence formation in the conditions of master's preparation and their didactic support is also revealed. The diagnostic block is aimed at determining the state of formation of career competence (criteria, indicators, levels), gives an idea of the mechanism of implementation of the developed model by comparing the results that were got with the predicted ones.In the course of the research the author came to the conclusion that the developed structural-functional model will allow to ensure the continuity of the educational process in the formation of career competence and will help to prepare a highly qualified manager in the field of education. It is of great practical importance that the results of pedagogical research can be used in the process of professional training in the field of education, adaptation, training of pedagogical staff of educational institutions; while writing textbooks, training manuals, master's and diploma theses.

Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members.

Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists. Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation. Results In total, 298 answered the survey. 46.3% ( N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% ( N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure ( N = 185, 62.1%). Surgeons were more likely to offer the procedure ( N = 133, 55.4%) if motion preservation had to be maximized ( N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception ( N = 224, 84.2%) or diminished protective reflex ( N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation. Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.

Botulinum Toxin A, a Better Choice for Skeletal Muscle Block in a Comparative Study With Lidocaine in Rats.

A positive response to scalene muscle block (SMB) is an important indication for the diagnosis of thoracic outlet syndrome. Lidocaine injection is commonly used in clinical practice in SMB, although there have been some cases of misdiagnosis. Botulinum toxin A (BTX-A) is one of the therapeutic agents in SMB, but whether it is also indicated for SMB diagnosis is controversial. To evaluate the muscle block efficiency of these two drugs, the contraction strength was repeatedly recorded on tibialis anterior muscle in rats. It was found that at a safe dosage, 2% lidocaine performed best at 40 μL, but it still exhibits an unsatisfactory partial blocking efficiency. Moreover, neither lidocaine injection in combination with epinephrine or dexamethasone nor multiple locations injection could improve the blocking efficiency. On the other hand, injections of 3, 6, and 12 U/kg BTX-A all showed almost complete muscle block. Gait analysis showed that antagonistic gastrocnemius muscle, responsible for heel rising, was paralyzed for nonspecific blockage in the 12 U/kg BTX-A group, but not in the 3 U/kg or 6 U/kg BTX-A group. Cleaved synaptosomal associated protein 25 (c-SNAP 25) was stained to test the transportation of BTX-A, and was additionally observed in the peripheral muscles in 6 and 12 U/kg groups. c-SNAP 25, however, was barely detectable in the spinal cord after BTX-A administration. Therefore, our results suggest that low dosage of BTX-A may be a promising option for the diagnostic SMB of thoracic outlet syndrome. SIGNIFICANCE STATEMENT: Muscle block is important for the diagnosis and treatment of thoracic outlet syndrome and commonly performed with lidocaine. However, misdiagnosis was observed sometimes. Here, we found that intramuscular injection of optimal dosage lidocaine only partially blocked the muscle contraction in rats, whereas low-dosage botulinum toxin, barely used in diagnostic block, showed almost complete block without affecting the central nervous system. This study suggests that botulinum toxin might be more suitable for muscle block than lidocaine in clinical practice.

Mortality in persons with recent primary or secondary care contacts for mental disorders in Finland

Mortality in persons with recent primary or secondary care contacts for mental disorders in Finland

The origin and course of the infrapatellar branch of the saphenous nerve: An anatomical study

SummaryNerve injury of the saphenous nerve or infrapatellar branch seems to be a frequent complication following knee surgery or trauma. Denervation results vary, and in some cases, no pain relief is achieved. This might be due to anatomic variation. The purpose of this anatomical study is to identify the variation in the course of the infrapatellar branch and saphenous nerve.We dissected 18 cadavers from adult donors. Medial to the knee, the saphenous nerve and infrapatellar branch were identified and followed proximally to the point where the infrapatellar branch branched from the saphenous nerve. The location where the infrapatellar branch came off from the saphenous nerve relative to the knee joint and where it passed the knee joint were measured.A total of 23 infrapatellar branches were found. We identified 10 branches between 0–10 cm proximal to the knee joint, 3 branches at 10–20 cm, and 9 branches at >20 cm. Between the patella and semitendinosus tendon, the knee joint was crossed by 5 branches in the anterior, 15 in the middle, and 2 in the posterior one-third.The origin of the infrapatellar branch and the location at which it passes the knee are highly variable. This, in addition to people having multiple branches, might explain why denervation is frequently unsuccessful. Based on the anatomical findings, we propose a more proximal diagnostic nerve block to help differentiate between a distal-middle or proximal origin of the infrapatellar branch. Appropriate placement of the nerve block might help identify people who benefit from denervation.

Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain.

The objective of this peripheral nerve stimulation consensus guideline is to add to the current family of consensus practice guidelines and incorporate a systematic review process. The published literature was searched from relevant electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from database inception to March 29, 2021. Inclusion criteria encompassed studies that described peripheral nerve stimulation in patients in terms of clinical outcomes for various pain conditions, physiological mechanism of action, surgical technique, technique of placement, and adverse events. Twenty randomized controlled trials and 33 prospective observational studies were included in the systematic review process. There is Level I evidence supporting the efficacy of PNS for treatment of chronic migraine headaches via occipital nerve stimulation; chronic hemiplegic shoulder pain via stimulation of nerves innervating the trapezius, supraspinatus, and deltoid muscles; failed back surgery syndrome via subcutaneous peripheral field stimulation; and lower extremity neuropathic and lower extremity post-amputation pain. Evidence from current Level I studies combined with newer technologies facilitating less invasive and easier electrode placement make peripheral nerve stimulation an attractive alternative for managing patients with complex pain disorders. Peripheral nerve stimulation should be used judiciously as an adjunct for chronic and acute postoperative pain following adequate patient screening and positive diagnostic nerve block or stimulation trial.

Surgical Treatment Strategies for Injuries of the "Unforgiving" Superficial Branch of the Radial Nerve.

Neuropathic pain caused by adhesions or neuroma formation of the superficial branch of the radial nerve (SBRN) is difficult to treat. The authors evaluated the effectiveness of different routinely used surgical techniques for SBRN neuralgia to provide a basis for future studies on SBRN neuralgia and explored the prognostic value of a preoperative diagnostic nerve block. The authors performed a retrospective cohort study by reviewing surgical records for procedures to treat SBRN neuralgia. Patient satisfaction was scored as satisfied or unsatisfied, and pain intensity was scored with a numeric rating scale. The authors included 71 patients who had 105 surgeries on the SBRN. Patients with a neuroma ( n = 43) were most satisfied after proximal denervation with burying into the brachioradialis muscle compared with burying elsewhere (53 versus 0 percent; p < 0.001). Adhesions of the SBRN ( n = 28) were treated with neurolysis (39 percent satisfied). If neurolysis or denervation did not suffice, an additional denervation of the lateral antebrachial cutaneous nerve or posterior interosseous nerve led to satisfaction in 38 percent. A decrease of less than 3.5 points on the numeric rating scale score after diagnostic nerve block led to higher postoperative pain scores (4.0 versus 7.5; p = 0.014). The authors found that the outcome of the diagnostic nerve block can predict the outcome of SBRN denervation and burying into brachioradialis muscle. The most effective burying technique is burying the SBRN into the brachioradialis muscle. Future studies on the treatment of SBRN neuralgia should therefore compare newer techniques, with burying the SBRN into the brachioradialis muscle as the control group.

Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization may help identify cervicogenic headaches: a case–control study

ABSTRACT Background The relative value of clinical tests toward identifying cervicogenic headache (CGH) remains under investigated. Whilst certain physical examination findings have been associated with CGH, consensus on which findings provide the strongest association remains elusive. Objectives To determine which cervical musculoskeletal assessment procedures used in CGH are positively associated with CGH. Design Single blind observational study Methods Four selected musculoskeletal assessment procedures of the cervical spine, craniocervical flexion test, cervical flexion-rotation test, cervical retraction range of motion and reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization, were applied to 20 headache and 20 controls. Inclusion criteria for the headache group met the International Headache Society criteria for CGH except positive diagnostic blocks. Results Upper cervical spine sustained joint mobilization testing associated with reproduction and resolution of familiar head pain was strongly associated with CGH (Odds Ratio = 36, p < 0.01). This was 78% sensitive and 90% specific in identifying CGH. Other physical tests were not statistically associated with CGH. Conclusions Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization is effective in differentiating those with CGH from control participants. Other cervical measures did not clearly identify CGH in this study.

A Novel Approach to New Onset Hemiplegic Shoulder Pain With Decreased Range of Motion Using Targeted Diagnostic Nerve Blocks: The ViVe Algorithm

A Novel Approach to New Onset Hemiplegic Shoulder Pain With Decreased Range of Motion Using Targeted Diagnostic Nerve Blocks: The ViVe Algorithm

MODERN PROBLEMS OF PROFESSIONAL TRAINING OF PHILOLOGY STUDENTS

The article discusses the lack of professional interest in intercultural interaction as one of the modern problems of teaching philology students. Attention is paid to the role of intercultural interaction in the professional activities of philologists, to the theoretical understanding of the mechanisms for increasing the efficiency of its formation in the course of professional training. In the study, the professional interest of philology students in intercultural interaction is interpreted as a cognitive and activity orientation of the individual to master knowledge, skills and abilities to establish mutual understanding, productive dialogue, interaction and cooperation with representatives of other cultures and languages, acting as a stimulator of personality activity during the period of professional training. The theoretical and practical significance of the work lies in the direction of its results to improve the process of professional and personal development of philology students, in the development of mechanisms to increase the efficiency of forming their professional interest in multicultural interaction. The author proposes a technology for the formation of professional interest in intercultural interaction, which is a set of interrelated methodological, organizational, methodological and diagnostic blocks that determine the selection, layout and procedure for using forms, methods and teaching aids to achieve the planned result in the course of professional training of philology students. In addition, a necessary factor in increasing the effectiveness of the formation of professional interest in intercultural interaction is the pedagogical monitoring of its formation at all stages of the professional training of future philologists.

Abstract SY25-02: Double-edged “soil”: Stromal microenvironment in breast cancer development

Abstract SY25-02: Double-edged “soil”: Stromal microenvironment in breast cancer development

Comparison between intra-articular and combined intra- and periarticular sacroiliac injection: a prospective randomized controlled clinical trial.

Sacroiliac joint dysfunction is one of the most common causes of low back pain. The aim of our study was to determine whether combined injection (intra and periarticular) of sacroiliac joint provides greater pain relief than intra-articular injection. This is a randomized controlled trial between two groups. The first group involved thirty patients treated with combined injection (intra- and periarticular) of a mixture of methylprednisolone acetate 40 mg and local anesthetic into a symptomatic sacroiliac joint. The second group (30 patients) received the same mixture only intra-articular. Diagnostic block was done for all cases. All patients failed to respond to medical treatment before proceeding to the injection procedure. Over 6 months of follow-up, there were statistically significant improvements in patients who received combined sacroiliac joint injection according to pain Visual Analog Scale (VAS) compared with intra-articular group. Comparing both groups, there was significant difference in the 1-month VAS (one month after the procedure) as the P value was 0.010, and in the 6-month VAS (6 months after the procedure) as the P value was 0.007. There was no significant difference in the pre-VAS (P value was 0.795) and immediate post-VAS (one week after the procedure) as the P value were 0.145. No complications were reported after the procedure. Although both groups provide statistically significant pain relief, patients who received combined sacroiliac joint injection have significantly greater clinical improvement as regard to those who received only intra-articular injection.

ID:15924 Successful Treatment of T4 Syndrome With Thoracic Sympathetic Nerve Block: A Medically Complex Case

33-year-old man was referred for 10+ year history of intermittent right sided thoracic back pain, scapular stiffness and muscle spasms, as well as proximal right upper extremity pain. Pain described as spasms, throbbing, shooting, punishing and exhausting that lasts for days and occurs multiple times per week. Pain intensity was 6-8/10 on the numerical pain rating scale (NRS). Exercise exacerbates his symptoms. The patient failed previous conservative treatments and alternative therapies. No improvement with pain medications or previous interventional treatment including thoracic medial branch blocks and prolotherapy. Exam notable for tightness with radiation of the posterior shoulder girdle (between the thoracic spine and medial border of scapula), right biceps and into the first and second digits. Diagnostic testing including radiographs and CT were normal, ruling out musculoskeletal abnormalities. Cervical MRI demonstrated mild degenerative disc disease at C4-7, however thoracic MRI was within normal limits ruling out degenerative or discogenic etiology. EMG nerve conduction study was normal eliminating potential long thoracic nerve syndrome. After thorough evaluation and failing physical therapy costotransverse dysfunction was ruled out. Suspecting T4 syndrome, the patient underwent a diagnostic and therapeutic right T2 thoracic sympathetic block under fluoroscopic guidance.

A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework.

Introduction: With an increasingly ageing population, there is a growing impact of fragility hip fracture on the healthcare system and on society as a whole. Oral and injectable analgesics are often insufficient whilst traction and regional blocks do not allow patients to be discharged easily. While the conventional approach of ultrasound-guided anterior hip pericapsular neurolysis can help a lot of inoperable hip fracture patients to relieve their fracture pain and facilitate subsequent nursing care, enormous technical challenges are encountered in some cases. In this retrospective case study, we evaluated the overall pain and functional outcomes of our modified approach of anterior hip pericapsular neurolysis for inoperable hip fractures using the IDEAL framework. Method: This retrospective case series studied patients with acute inoperable hip fracture who received the modified approach of anterior hip pericapsular neurolysis from January 2018 to June 2019 according to the IDEAL recommendations. The modified approach consisted of pericapsular nerve group (PENG) injection, iliopsoas plane infiltration, and the sagittal approach of obturator nerve articular branches (ONAB) injection. Subsequent alcohol neurolysis would be performed in the same setting if there were positive diagnostic blocks. Assessments were carried out on post-intervention day 5. The primary outcome was pain intensity during hip flexion at 80 degrees in the recumbent position and during gentle hip internal and external rotation using an appropriate pain scoring tool. The secondary outcomes were the range of tolerable hip flexion and occurrence of any lower limb neurological deficit because of the procedure. Interim outcomes were also briefly evaluated. Results: Among the 74 patients who were reviewed in the study period, the median dynamic pain at hip flexion 80° (p < 0.001) and on gentle hip external and internal rotation (p < 0.001) was significantly reduced from a composite score of 3 (severe pain) to 1 (mild pain) on post-intervention day 5 after the modified approach of hip neurolysis. This translated to 72% of patients achieving satisfactory pain control, which was defined as a composite pain score of ≤1 on hip flexion at 80°. Functionally, the mean range of tolerable hip flexion significantly improved from 39.7° at baseline to 74° on post-intervention day 5 (p < 0.001). Transient and reversible hypotension was seen in about 10% of the patients. No other major procedural adverse event was noted. Interim follow-up at 4–6 months post-intervention revealed that more than 95% of patients continued to have satisfactory dynamic pain control (i.e., composite pain score ≤ 1). According to the IDEAL classification, this study could be ranked as stage 2a (development). Conclusions: Our findings suggested that anterior hip pericapsular neurolysis using a modified approach could offer consistent and satisfactory analgesic and functional benefits to a majority of patients with inoperable hip fractures during the interim of the fracture healing process, and it was potentially safer than the conventional approach. This technique might have achieved its readiness to proceed to the next stage of research according to the IDEAL framework.