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Femoral fracture – nerve block — RACP Paediatrics MCQ

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HardEmergencyFemoral fracture – nerve blockRACP Paediatrics

A 6-year-old with an isolated displaced femoral-shaft fracture has received systemic analgesia but still has severe pain during splinting. Neurovascular examination is documented and ultrasound expertise is available. Which single regional technique offers the best targeted analgesia?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Perform an ultrasound-guided fascia iliaca compartment block

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · C = shown as D · A = shown as E

E is correct. E fascia iliaca compartment block provides rapid, effective regional analgesia for femoral fractures and is simpler and lower risk than attempting direct femoral-nerve placement; ultrasound improves safety when expertise is available. A anaesthetises distal lower-leg structures and does not cover femoral pain. B targets the upper limb. C cannot block the proximal femoral and lateral femoral cutaneous nerves responsible for fracture pain. D targets abdominal-wall nerves. The block supplements, rather than replaces, multimodal analgesia, fracture alignment, repeated neurovascular assessment and local-anaesthetic dose checking.

Reference: Royal Children’s Hospital Melbourne: Fascia iliaca block of the femoral nerve: https://www.rch.org.au/clinicalguide/guideline_index/Fascia_iliaca_block_of_the_femoral_nerve/