Orthopaedics Lower Limb: Fracture Shaft of Femur

Question 1

The Bromage Scale is a

Answer 1

Measure of motor block from the effects of epidural anaesthetic

Question 2

Why is it important to assess motor block via the Bromage Scale?

Answer 2

It is important to assess motor block to determine the amount of motor function; to prevent pressure areas; to ensure the patient is safe to ambulate (if allowed); and to detect the onset of complications e.g. epidural haematoma or abscess)

Question 3

What is Bromage 0; 1; 2; and 3?

Answer 3

Bromage 0 (none - full flexion of knees and feet)
Bromage 1 (partial - just able to move knees)
Bromage 2 (almost complete - able to move feet only)
Bromage 3 (complete - unable to move feet or knees)

Question 4

What are some complications that can arise from a shaft of the femur fracture?

Answer 4

Infections, embolism, long-term pain (usually irritation from a distal screw or nails used), leg indescriptancy (i.e. 1cm) therefore altered biomechanics load on other structures

Question 5

What is the typical surgical management of a shaft of femur fracture?

Answer 5

Intramedullary nail. Has union rates between 95 and 99%

Question 6

How much blood loss is associated with a fracture of the shaft of femur?

Answer 6

Between 1000 and 1500 mls; blood loss can be doubled in an open fracture. Can result in low haemoglobin possibly leading to hypovolemic shock.

Question 7

What is the different between and open fracture and a closed fracture?

Answer 7

An open fracture is a broken bone that penetrates the skin. A closed fracture is a broken bone that doesn’t penetrate the skin

Question 8

What are some complications/risks associated with an open fracture?

Answer 8

Requires urgent surgery to clean the area of injury because the break in the skin can result in debris and infection traveling to the fracture location with a high chance of infection occurring in the bone.

Open fractures usually take longer to heal because of the extent of the injury to the bone and surrounding soft tissue. High rate of complications including infection and non-union.

Question 9

What would be some emergency care of an open fracture?

Answer 9

Antibiotics, cleaning of the fracture site and stabilisation of the bones.

Question 10

Mechanism of injury and gender commonly associated with a femoral shaft fracture?

Answer 10

High energy trauma - Young Adults
Low energy trauma - Older Adults
Common trauma includes motor vehicle collisions, pedestrians struck by a motor vehicle, motorcycle accidents, fall from a height of three meters or greater and gunshot wounds