Considerable force may be associated with a femoral fracture, although this injury may occur after apparently minor twisting.
Assume major traume involved until excluded.
- Assess ABC and call for help if required
- Trauma call if in doubt
- Actively seek/manage shock and other injuries
- Early analgesia (including Thomas splint)
- Record neurovascular status
- Early IN Fentanyl
- IV access (morphine) will be required at some stage
- US guided femoral nerve block
- Allow time (15 min) for a femoral block to work
- Apply skin traction (You may need gallows traction in smaller children). It is a priority to get the child in traction
- If there is an obvious femoral fracture the child should be in traction before imaging