Initial Management of Closed Femur Fracture with Deformity
Pain control is the initial management priority for a closed femur fracture with deformity, as these fractures are extremely painful and effective analgesia is the foundation of acute care before definitive stabilization. 1
Immediate Pain Management Algorithm
First-line analgesia:
- Administer regular paracetamol (acetaminophen) immediately unless contraindicated, as this is the recommended first-line analgesic for femur fractures 1, 2
- Approximately 40% of fracture patients have moderate renal dysfunction requiring dose adjustment, so verify renal function before escalating therapy 1, 2
Second-line analgesia:
- Add opioid analgesia cautiously, with reduced dosing in elderly patients or those with unknown renal function to avoid adverse effects 1, 2
- Document pain scores before and after analgesia to guide ongoing management 1
Advanced regional analgesia:
- Consider femoral nerve block or fascia iliaca block for superior pain control, though these may not reliably block all three nerves (femoral, obturator, lateral cutaneous nerve of thigh) 3, 1
- Psoas compartment block is the most reliable method for blocking all three nerves, though it carries risks of neuraxial blockade and deep hematoma formation in anticoagulated patients 3
Critical medication pitfall:
- Avoid NSAIDs until renal function is confirmed, as they are relatively contraindicated in this population with high rates of renal impairment 1, 2
Immediate Immobilization
- Immobilize the limb immediately to minimize pain and prevent further soft tissue injury 1, 2
- The affected leg will characteristically appear shortened and externally rotated, which is pathognomonic for femur fracture 2
- Splint the fractured extremity in the position found unless straightening is necessary to facilitate safe transport 1
Why Pain Control Takes Priority Over Other Options
Regarding the specific answer choices:
- Soft tissue damage (Option A): While immobilization does reduce further soft tissue injury, this is a secondary benefit of pain management and immobilization, not the primary initial goal 1
- Bleeding control (Option B): This is not applicable since the question explicitly states there is no bleeding, and closed femur fractures have minimal blood loss at the injury site 1, 4
- Joint movement preservation (Option C): This is a long-term concern addressed during definitive surgical management, not an initial management priority 4
- Pain control (Option D): This is the correct answer, as effective analgesia is the foundation of acute care and enables all subsequent interventions 1