Introduction to Femur Fractures
A femur fracture, or a break in the thigh bone, is one of the most severe orthopedic injuries due to the femur’s role as the body’s longest and strongest bone. These fractures often result from high-impact trauma (e.g., car accidents, falls) or pathological conditions like osteoporosis. Effective nursing care is critical to mitigate complications, promote healing, and restore mobility. This guide provides a step-by-step nursing care plan tailored to femur fracture patients, grounded in clinical best practices.
Anatomy and Types of Femur Fractures
Anatomy of the Femur
The femur consists of three regions: the proximal end (hip joint), the shaft (mid-section), and the distal end (knee joint). Its robust structure supports body weight, making fractures debilitating and often requiring surgical intervention.
Classification of Femur Fractures
- Proximal Femur Fractures: Includes femoral neck and intertrochanteric fractures. Common in older adults with osteoporosis.
- Femoral Shaft Fractures: Mid-shaft breaks, often from high-force trauma. May involve comminution (bone shattered into pieces).
- Distal Femur Fractures: Occur near the knee, affecting the condyles. Associated with ligament/tendon damage.
- Open vs. Closed Fractures: Open fractures break the skin, raising infection risks.
Initial Nursing Assessment for Femur Fractures
Primary Survey: ABCDE Approach
Assess for life-threatening conditions first (Airway, Breathing, Circulation, Disability, Exposure). Femur fractures can cause significant blood loss (up to 1–1.5 liters in the thigh), leading to hypovolemic shock.
Focused Musculoskeletal Assessment
- Pain Assessment: Use a validated scale (e.g., Wong-Baker FACES). Document location, intensity, and quality.
- Neurovascular Evaluation: Check pulses (femoral, popliteal, dorsalis pedis), capillary refill (<3 seconds), sensation, and motor function.
- Deformity and Swelling: Look for limb shortening, rotation, or crepitus.
- Skin Integrity: Identify open wounds or bruising.
Diagnostic Tests
- X-rays: Confirm fracture location and pattern.
- CT/MRI: Assess soft tissue damage or complex fractures.
- Lab Work: CBC (for anemia), coagulation studies, and electrolytes.
Nursing Diagnoses for Femur Fractures
Prioritize diagnoses using clinical judgment and patient-specific data:
- Acute Pain related to bone displacement and muscle spasms.
- Impaired Physical Mobility due to immobilization devices (casts, traction).
- Risk for Infection (surgical site, open fractures).
- Risk for Peripheral Neurovascular Dysfunction from swelling or compartment syndrome.
- Risk for Deep Vein Thrombosis (DVT) due to immobility.
- Deficient Knowledge regarding recovery protocols.
Planning and Goal Setting
Short-Term Goals (0–7 Days)
- Reduce pain to ≤3/10 on the pain scale within 48 hours.
- Prevent DVT through early mobilization and anticoagulants.
- Minimize swelling via elevation and cold therapy.
Long-Term Goals (2–12 Weeks)
- Restore full weight-bearing mobility by 12 weeks.
- Achieve fracture union confirmed by imaging.
- Educate patients on fall prevention and home safety.
Nursing Interventions and Rationales
1. Pain Management Strategies
Pharmacological Interventions
- Opioids: Morphine or hydromorphone for acute pain post-surgery.
- NSAIDs: Ibuprofen for inflammation (avoid in older adults with renal issues).
- Adjuvants: Muscle relaxants (e.g., cyclobenzaprine) for spasms.
Non-Pharmacological Interventions
- Cold Therapy: Apply ice packs for 20 minutes hourly to reduce edema.
- Positioning: Elevate the limb above heart level using pillows.
- Distraction Techniques: Music therapy or guided imagery.
2. Promoting Mobility and Preventing Complications
Early Mobilization
- Bed Exercises: Ankle pumps, quadriceps sets, and gluteal squeezes hourly.
- Assistive Devices: Teach crutch or walker use with non-weight-bearing (NWB) guidelines.
- Physical Therapy: Gait training starting 24–48 hours post-surgery.
DVT Prophylaxis
- Anticoagulants: Enoxaparin 40 mg subcutaneous daily.
- Compression Devices: Sequential compression devices (SCDs) while bedridden.
- Hydration: Encourage 2–3 liters of fluids daily to prevent hypercoagulability.
Infection Prevention
- Wound Care: Clean surgical incisions with sterile technique; monitor for erythema or drainage.
- Antibiotics: Administer pre-operative cefazolin (or vancomycin for MRSA).
3. Neurovascular Monitoring
Assess every 2–4 hours for:
- 6 Ps: Pain, Pallor, Paresthesia, Paralysis, Poikilothermia, Pulselessness.
- Compartment Syndrome: Severe pain unrelieved by analgesics, taut swelling. Emergency fasciotomy required.
4. Nutritional Support for Bone Healing
- Protein: 1.2–1.5 g/kg/day (e.g., lean meats, legumes).
- Calcium & Vitamin D: 1200 mg calcium and 800–1000 IU vitamin D daily.
- Vitamin C and Zinc: Promote collagen synthesis (citrus fruits, nuts).
5. Psychosocial Support
- Address anxiety or depression related to immobility.
- Connect patients with support groups or counseling.
Patient and Family Education
Pre-Discharge Teaching
- Medication Adherence: Emphasize anticoagulant schedules.
- Weight-Bearing Restrictions: NWB for 6–8 weeks, progressing to partial weight-bearing (PWB).
- Home Safety: Remove tripping hazards, install grab bars.
Signs of Complications
- Infection: Fever, purulent drainage, increased pain.
- DVT: Unilateral leg swelling, warmth.
- Compartment Syndrome: Numbness, unbearable pain.
Interprofessional Collaboration
- Orthopedic Surgeons: Monitor surgical repair (e.g., intramedullary nailing).
- Physical Therapists: Design rehab programs for strength and ROM.
- Dietitians: Optimize nutrition for bone healing.
Monitoring and Evaluation
- Weekly Assessments: Track pain, mobility, and wound healing.
- Imaging: X-rays at 6 and 12 weeks to evaluate callus formation.
- Functional Outcomes: Use tools like the Harris Hip Score or Timed Up-and-Go test.
FAQs: Addressing Common Concerns
Q: How is a femur fracture treated surgically?
A: Intramedullary nailing (rod inserted into the bone marrow) is the gold standard for femoral shaft fractures. Proximal fractures may require hip replacement or screws.
Q: Can a femur fracture heal without surgery?
A: Non-surgical management (traction, casting) is rare and reserved for non-displaced fractures or patients unfit for surgery.
Q: What’s the role of weight-bearing in recovery?
A: Early NWB prevents stress on the fracture. Gradual progression to full weight-bearing (FWB) occurs over 3–6 months.
Q: How to prevent femur fractures in older adults?
A: Fall prevention strategies (balance exercises, home modifications), bone density screenings, and calcium/vitamin D supplementation.
Conclusion
A meticulous nursing care plan for femur fractures integrates pain control, early mobilization, complication prevention, and patient education. By adhering to evidence-based interventions and fostering interprofessional collaboration, nurses play a pivotal role in achieving optimal patient outcomes and reducing hospital readmissions.
