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Painful femoral fracture — DipIMC MCQ

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HardTraumaPainful femoral fractureDipIMC

A patient has a severely deformed ankle fracture-dislocation with an absent dorsalis pedis pulse. Analgesia has been given and immediate transfer will take forty minutes. What should a competent clinician do?

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Correct answer: D — Realign the limb now, then reassess and document distal perfusion

The best answer is “Realign the limb now, then reassess and document distal perfusion”. NICE recommends realigning a deformed limb before splinting when distal perfusion is absent, performed by a competent practitioner after analgesia. Reassess and document pulse, capillary refill, sensation and motor function before and after, then splint and transfer urgently. Imaging must not delay restoration of threatened perfusion, while a femoral traction device is not designed for an ankle fracture-dislocation.

Reference: NICE NG37, Fractures (complex): https://www.nice.org.uk/guidance/ng37/chapter/recommendations