Femur Fracture Treatment & Management
- Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH more...
Prehospital personnel should splint the extremity in the position it was found. If signs of neurovascular compromise are observed, the limb may be reduced after administering adequate analgesia. Well-aligned fractures, with or without neurovascular injury, can be immobilized by using a traction device. Hare or Thomas traction splints are most commonly used.
Apply wet sterile dressings over an open fracture. If the wound is grossly contaminated, sterile saline irrigation may be used to remove large contaminants.
Emergency Department Care
Fracture reduction and immobilization: Reduce fractures to near-anatomic alignment by using in-line traction, which reduces pain and helps prevent hematoma formation. Hold reduction by a traction device (eg, Hare, Buck) or long-leg posterior splint. Pneumatic splint may have additional benefits of reducing blood loss by direct pressure and tamponade of hematoma formation. Traction is often required to hold the femur out to length because of contraction of large muscle mass in the thigh.
Pain management: Pain management is the most significant intervention of the emergency physician. Use parenteral opiate-type analgesics to the extent that respiratory and circulatory parameters allow. Intravenous administration allows for the most reliable titration to pain relief while providing ready access for reversal agents (ie, naloxone) if necessary.
Infection prophylaxis: With open fractures, administer tetanus toxoid (unless given within 5 y) and use antibiotics with excellent staphylococcal coverage and good tissue penetration. Often, a first-generation cephalosporin (ie, cefazolin sodium) is administered in combination with gentamicin.
In addition to maintenance intravenous fluids, patients suspected of significant blood loss should be resuscitated with crystalloids. Place a Foley catheter, and restrict all patients to taking nothing by mouth (NPO) until seen by an orthopedic surgeon.
Emergently consult an orthopedic surgeon.
Evidence of vascular or progressing neurologic compromise should prompt emergent consultation with a vascular surgeon. In some hospitals, the general surgeon may have privileges for vascular intervention.
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