Fall Scenario

As you start your observations, you complete a quick primary survey and briefly assess the injury. What obvious sign is more indicative of a neck of femur fracture when first assessing an injury to the hip?

Why does the leg present in a shortened and externally rotated position?

You note this presentation in the patient’s leg and suspect a neck of femur fracture. The observations you then collect are: HR 105, RR 20, SpO₂ 98%, BP 142/78, Temp 36.8, BM 5.6. What is this patient’s NEWS score?

As you collect your observations, you notice the patient does not appear bothered about her injury and is chatting in a confused manner, as she normally does. Her baseline behaviour is that she cannot understand most subjects and is unable to hold a conversation. She is physically very well, but her cognitive ability is severely declined. You ask her if she is in any pain, but she states that she has no pain. What scoring tool can you use to help you measure this patient’s pain?

You apply the Abbey Pain Scale to your patient and find a score of 9. What does this equate to?

As you have completed your basic observations and Abbey Pain Scale assessment, you look to administer pain relief. Why is early pain management important?

You begin your pain management strategy to make the patient more comfortable. You have already noted the leg is shortened and externally rotated, but what other signs may indicate a fractured neck of femur?

You see a number of signs associated with a neck of femur fracture. You have the prescription list for the patient. What medications may directly indicate the patient is at greater risk of fracture (rather than simply indicating increased frailty)?

Osteoporosis contributes to neck of femur fractures primarily by:

Once you have established a neck of femur fracture, should a neurovascular assessment distal to the injury be completed?

Once pain relief has been given and the patient appears more comfortable, you consider extrication. What does JRCALC recommend to immobilise the injured leg?

You immobilise the leg to provide comfort during extrication and use a scoop stretcher for transfer to hospital. Why is prompt conveyance to the nearest appropriate hospital important in suspected fractures?

Why do some patients report pain in their groin when they have sustained a neck of femur fracture further up the thigh?

You can rule out a suspected neck of femur fracture if the patient can weight bear and perform a straight leg lift, even if there is pain?

A neck of femur fracture can occur in the frail elderly population without any trauma. What is this type of fracture known as?

Which hormone deficiency commonly contributes to bone fragility in elderly females?

The arterial blood supply for the femoral head travels back up the bone towards the proximal femur and rests on the neck. Which artery supplies this anatomy?

Due to this artery travelling along the neck of the femur, displacement caused by an intracapsular (neck) fracture can disrupt blood flow. The femoral head may therefore experience: