Femur Fracture

Last Updated on by FRCEM Intermediate

Clinical features

  • Inability to weight bear
  • Shortened and externally rotated leg
  • Straight leg raise and hip movements globally inhibited by pain

Investigations

  • Plan film x-ray- If plain films are negative, but a fracture is still suspected then further imaging is required. Grounds for suspicion may include:
    • patient unable to weight bear
    • high-risk mechanism
    • severe osteoporosis
    • MRI is the investigation of choice. If unavailable, CT scan may be an option
  • blood for U&E, glucose, FBC, and cross-match.
  • Obtain an ECG to look for arrhythmias/MI and consider the need for CXR.
  • Arrange other investigations as indicated by history/examination

Management

  • Obtain IV access- Administer IV analgesia — give small increments of opioid (with an
    anti-emetic) until the pain is controlled
  • Start IV fluids  if indicated
  • Consider adding nerve blocks/prepare splint and immobilize in Thomas
  • Optimize medical comorbidities
  • Admit to the orthopedic ward within two hours of their arrival to the ED

Complications

  • Avascular necrosis of the femoral head (intracapsular > extracapsular)
  • Neurovascular damage
  • Dislocation of arthroplasty
  • Non-union
  • Compartment syndrome
  • Venous thromboembolism
  • Infection
  • Haematoma
  • Post-traumatic arthritis and chronic pain

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