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Primary treatment of an acute femoral neck fracture should be by a method that gives the lowest morbidity and mortality yet produces a good result in the majority of cases. This method would seem to be closed stable reduction and, if it fails, eventually open reduction followed by adequate internal fixation. Certain types of fractures are exceptions in which primary femoral head replacement seems to be the treatment of choice.

To the Editor:—The purpose of this letter is to publicize a simple technique of local anesthesia for anorectal surgery which evolved from that of Schneider1 and Salvati and Kratzer.2Patients are premedicated with an individualized dose of intramuscularly administered meperidine and atropine. The anesthetic solution is prepared by adding 2 ampules of hyaluronidase to 50 cc of 0.5% lidocaine with 1:200,000 epinephrine. The patient is placed in the prone jack-knife position and the perianal area is thoroughly cleaned. Extremely obese patients or those in whom an airway problem is anticipated are placed in lithotomy position. An intravenous infusion is then started and 2 cc of a solution containing 2 cc of a droperidol and fentanyl citrate mixture (Innovar) and 8 cc of saline is administered into the intravenous tubing. The remaining Innovar solution is administered intermittently during procedure, directly into the intravenous tubing.Perianal infiltration is begun