Initial Management of Right Femur Fracture with Deformity
Pain control (Option D) 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 Protocol
The initial approach must prioritize analgesia because femur fractures are particularly painful on movement, and pain control directly impacts morbidity and quality of life 2:
- Administer regular paracetamol immediately unless contraindicated, as this is the recommended first-line analgesic 1, 3
- Add opioid analgesia cautiously, particularly if the patient is elderly or has unknown renal function, as approximately 40% of femur fracture patients have moderate renal dysfunction requiring dose adjustment 1, 3
- Avoid NSAIDs until renal function is confirmed, as they are relatively contraindicated in this population with high rates of renal impairment 1, 3
- Document pain scores before and after analgesia administration to guide ongoing management 2
Concurrent Immobilization
While pain control is the priority, immobilize the limb immediately to minimize pain and prevent further soft tissue injury 1, 3. The affected leg will characteristically appear shortened and externally rotated 3. Immobilization reduces pain, reduces risk for further injury, and facilitates transport 1.
Why Other Options Are Secondary
- Soft tissue damage (Option A): In a closed femur fracture with no scar, soft tissue damage is already present but not the immediate priority; immobilization addresses this concern secondarily 1
- Bleeding control (Option B): In closed femur fractures with no bleeding, this is not the initial priority 1
- Joint movement preservation (Option C): This becomes relevant during rehabilitation after definitive fixation, not in initial management 4
Advanced Analgesia Considerations
If basic analgesia is insufficient, 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) 1. Psoas compartment block is the most reliable method for blocking all three nerves but carries risks of neuraxial blockade 1.
Critical Pitfall to Avoid
Do not delay pain assessment and management while focusing on other interventions 3. Early and effective analgesia is crucial and directly impacts patient outcomes, as early fracture fixation provides the most effective analgesia but requires initial pain control to facilitate safe transport and preparation 2.