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HWN Suggests

Femur Fracture in the ED – Remove the Traction

Patients with femoral shaft fracture will often come in with a Hare traction splint placed by EMS. This is called skin splinting and can do more damage than good. The theoretical benefit is pain control and fracture reduction, however a Cochrane review showed that it does not achieve either of these goals. The traction splint should be removed on arrival to the ED. It can result in neurologic damage and worsen injury at other sites. Femur fractures rarely result in femoral or sciatic nerve damage, as these are encased in muscle, however placement of a traction splint can stretch the nerves and cause damage. It can also cause skin breakdown at the sites where the splint attaches. Traction splints…

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 Emergency Department Application of J-splints to Temporize Pediatric Femur Fractures

The most common cause of femur fractures in children less than one year of age is NAT and some have suggested that NAT is prevalent in patients up to 5 years of age.

Articles of Interest

Age Matters: Managing Femur Fractures in Kids

A word on non-accidental injury: no individual fracture type can distinguish an accidental from a non-accidental injury. When a pediatric patient presents with a femur fracture, regardless of age, non-accidental trauma should be highly suspected. One potential predictor of whether or not a pediatric femoral fracture is caused by non-accidental injury is whether or not the child knows how to walk.

An Overview of Femur Fractures: Location, Imaging, Complications, and Management

This post will emphasize traumatic fractures as these represent a larger percentage of the femoral fractures we will see in the emergency department. Do not use traction devices for proximal femur fractures

Are you pulling my leg? Does the use of traction splints in the pre-hospital management of patients with femoral fractures reduce the incidence of complications compared to traditional splinting?

Traction splints are frequently applied incorrectly but no statistical increase in on-scene times was found. A statistically significant decrease in the need for blood transfusions was demonstrated with the application of a traction splint.

Avoid These Two Common Femoral Nerve-Block Errors

Classically, the femoral nerve sits just lateral to the femoral artery and is held in close approximation to the Iliac muscle by the fascia iliaca. Placing the ultrasound probe just below the inguinal crease with the probe marker aimed to the patient’s right allows clear visualization of relevant anatomy.

Best Practices: Tourniquets & Closed Femur Fractures?

I have never seen or heard of it being done. With high and tight tourniquet application, the tourniquet would be parallel to the casualty’s perineum. In most people, that corresponds to slightly below / distal to the greater trochanter of the femur (prominent point of the femur that you can feel by pushing on your outside “hip”). Since the proximal/high femur gets its blood supply from above the greater trochanter, tourniquet placement is not likely to decrease bleeding since the tourniquet, by definition, is below where the blood supply enters the high femur.

EM@3AM: Proximal Femur Fracture

Intertrochanteric fractures account for 50% of proximal femur fractures, with more females than males affected (3:1).

Femoral Fractures

The femur is the largest and strongest bone in the body. Due to its strength it requires a significant force to break it. However, certain medical conditions that weaken the bone make it more vulnerable to fracture, so called pathological fractures.

Femoral Neck Fractures

Occult fractures are common – proceed to advanced imaging if index of suspicion high.

Femoral nerve block for hip fractures: the evidence

Although imperfect, I think these studies make it pretty clear that femoral nerve blocks will decrease pain and decrease opioid use. However, the decreases in pain are pretty modest, and a decrease in opioid use is really a surrogate outcome.

Femoral Shaft Fractures

Femoral shaft fractures are commonly associated with multi-system trauma. Do not get distracted by the obvious injury. Always remember to complete a thorough trauma evaluation

Femoral Shaft Fractures - Peds

Femoral shaft fractures can happen at any age depending on mechanism however, there is a clear bimodal age distribution with increased rates in toddlers (between 2-4 years of age) and adolescents (approximately greater than 10 years of age). Any femur fracture before ambulatory age is uncommon and should be treated as suspicious for non accidental injury (NAI). This is especially true for femoral fractures in children less than 12 months of age

Femoral traction splints, helpful or not?

And certainly I don’t advocate not immobilizing the limb, as this clearly has benefit. But creating a make-shift splint needs to stop being taught as the best or only way to treat femur injuries. And simple splinting should be used until we have clear data showing a benefit to traction splinting.

Femur Fracture in a Newborn

This case illustrates the importance of careful physical examination and pause with diagnosis of congenital hip dislocation in a patient with additional risk factors.

Interventions for treating fractures of the distal femur in adults

Fractures of the distal femur (the far end of the thigh bone just above the knee) are a considerable cause of morbidity. Various different surgical and non‐surgical treatments have been used in the management of these injuries but the best treatment remains unknown.

Lightning Learning: Neck of Femur Fractures

If clinically the patient can’t weight bear, and the initial x-ray is negative. A CT or MRI will need to be considered to exclude a fracture.

Open Breaks - Initial Management

Many long bone open fractures carry a significant risk of life-threatening hemorrhage. A femur fracture, classically, is associated with significant blood loss from vascular injury. Bleeding may be controlled with direct pressure, fracture stabilization, or, in situations of arterial/massive hemorrhage, application of a tourniquet.

The Fractured Femur: Acute Emergency Care Treatment

Fractures of the femur are encountered relatively infrequently in general sports medicine. This is fortunate since this injury is extremely serious and is attended by a very substantial morbidity and occasional mortality.

Traction Splinting for midshaft femoral fractures in the pre-hospital and Emergency Department environment—A systematic review

Pain and hemorrhage are common in midshaft femoral fractures. Traction splints (TSs) can reduce pain and control hemorrhage, but evidence of their effectiveness in femoral fractures is still lacking.