Initial Management of Right Femur Fracture with Deformity
The correct answer is D - 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
Why Pain Control Takes Priority
In a closed femur fracture with no bleeding, pain management supersedes all other interventions because:
- Femur fractures are extremely painful, particularly on movement, and effective analgesia directly impacts morbidity and quality of life 2, 1
- The patient has no active bleeding requiring control (option B is not applicable here) 1
- Immobilization (which addresses soft tissue damage - option A) should occur simultaneously with pain control, but analgesia must be initiated first to enable safe positioning 1
- Joint movement preservation (option C) is a long-term concern addressed through early definitive fixation, not an immediate priority 2
Immediate Pain Management Protocol
Administer regular paracetamol (acetaminophen) immediately unless contraindicated, as this is the recommended first-line analgesic for femur fractures 1, 3
Add opioid analgesia cautiously, particularly if the patient is elderly or has unknown renal function, as approximately 40% of fracture patients have moderate renal dysfunction requiring dose adjustment 1, 3
Avoid NSAIDs entirely until renal function is confirmed, as they are relatively contraindicated in this population with high rates of renal impairment 1, 3
Consider femoral nerve block or fascia iliaca block for superior analgesia, though these may not reliably block all three nerves (femoral, obturator, lateral cutaneous nerve of thigh) 1
Concurrent Immobilization
Immobilize the limb immediately after initiating analgesia to minimize pain and prevent further soft tissue injury 1, 3
- The affected leg will characteristically appear shortened and externally rotated 3
- Splinting the fractured extremity reduces pain, reduces risk for further injury, and facilitates transport 1
- It is reasonable to treat the deformed fracture in the position found unless straightening is necessary to facilitate safe transport 1
Critical Pitfalls to Avoid
Do not delay pain assessment and management while focusing on other interventions - document pain scores before and after analgesia to guide ongoing management 1, 3
Do not use standard opioid dosing in elderly patients without considering renal function, and do not prescribe NSAIDs without checking renal function first 1, 3
Do not assume bleeding control is needed when there is no active hemorrhage - isolated femur fractures rarely cause hemorrhagic shock, and shock in this setting should prompt investigation for other bleeding sources 4