Overview of Femur Immobilization
Immobilizing the thigh bone, or femur, is often necessary due to injuries like fractures (breaks in the bone) and dislocations (where a bone slips out of its normal position). Each of these injuries requires different methods of keeping the thigh bone stable. Immediately after the injury, doctors might use external devices that can help with moving the patient and other aspects of treatment.
The most common reason for these injuries is trauma, which can cause either an open fracture (where the broken bone is visible through an open wound) or a closed fracture (where the bone is broken but there’s no open wound visible). Regardless of whether the fracture is open or closed, the general principles of stabilizing the bone are similar.
Late in the treatment process, doctors have other options for keeping the thigh bone stable as the injury heals.
Anatomy and Physiology of Femur Immobilization
The femur, or thigh bone, is the largest and strongest bone in the body. It starts at the hip joint, where it connects to the pelvis, and extends down to the knee joint, where it meets the top part of the shin bone, also known as the tibia. This bone has several parts where muscles attach, making it a crucial part of movement and stability. Fractures, or breaks, in the femur are often named based on where they occur on the bone.
Different parts of the femur have specific names. The “femoral shaft” is the long, central section of the bone which is often broken in injuries. The “head of the femur” is the top part of the bone that directly links to the hip joint. The “femoral neck” is the small piece of bone that connects the head of the femur to the shaft. The “greater and lesser trochanter” are bumps of bone on the top end of the femur – these help doctors locate fractures. The bottom end of the femur has parts called condyles and epicondyles, which are involved in the knee joint and where muscles attach.
When a leg is injured, it’s important to examine it thoroughly. This includes checking how well blood is flowing to the leg, whether the nerves are working properly, and if the person can move their leg. Why? Because when someone injures their femur, other parts of the leg might get hurt too. Lack of blood flow, loss of sensation, or problems moving the leg could point towards serious injuries. These signs should be checked both before and after the leg is stabilized to make sure further damage isn’t being done.
Why do People Need Femur Immobilization
It can be challenging to identify certain types of broken bones (fractures) early, particularly those that haven’t moved out of place or if there’s uncertainty over whether a bone is broken or dislocated (out of joint), or both. If someone is hurt and shows signs such as marked changes to their leg shape, pain, swelling or the leg appearing shorter than the other, it’s a good idea to keep the leg still to prevent further damage. This also applies if the injured person is refusing to move their leg, is keeping it in a fixed position, or showing other signs of injury.
Often, if someone has a broken thigh bone (femur), applying a pulling force can significantly reduce the pain. This pulling force can be maintained with a special leg splint, which helps keep the leg stable.
In a hospital environment, if a bone is dislocated, it’s best to try and get it back in position as soon as possible. However, if this isn’t successful due to other severe, life-threatening conditions needing treatment first, keeping the leg still isn’t absolutely necessary. However, it’s usually preferable to keep the leg in a comfortable position until surgery can be performed to fix the issue.
The initial approach to keeping the leg still in the emergency department could be guided by the location of the fracture or the need to address other more critical, life-threatening injuries first.
When a Person Should Avoid Femur Immobilization
There are a few reasons why a doctor might decide not to use a splint or other methods to keep a bone in place while it heals. One of the main reasons is if the patient does not want it. Certain types of splints work better for specific kinds of fractures, but if a fracture is thought or confirmed to be present, there are no absolute reasons why a splint using standard guidelines cannot be used.
It can be challenging to use traction splints, which pull the broken bone into the right position, for injuries to the lower leg, especially if there are also injuries to the ankle or foot that make it impossible or too uncomfortable to attach the straps. In situations like these, some methods to immobilize the bone might not be the best choice, but other options should be available.
Equipment used for Femur Immobilization
In simple terms, anything strong, big, and long enough can be used to keep a joint from moving to prevent further injury. This applies not only to your hip and knee but when in a situation with no medical equipment around, you can use this same idea to create a temporary solution.
Different tools are available to help immobilize, or keep still, the femur bone in your leg. Medical professionals on the scene typically use specially-made traction splints. These include a solid piece that they fasten to the patient using straps and then gently pull taut with cords and devices to apply tension.
In the hospital, the doctors might use weighted traction splints, which use weight to provide the pull. They can do this in one of two ways. The less invasive way involves strapping onto the ankle and making sure the injured leg is kept straight. The weight is then hung from the end of the bed, usually through the use of a frame and pulley system.
Some serious fractures might require pins to be inserted into the leg bone near the knee or thigh, which then allows the doctors to apply skeletal traction. They put these pins in with great care to maintain cleanliness and prevent infection. This procedure usually requires specific tools that are found in orthopedic (bone specialist) surgery setups.
Who is needed to perform Femur Immobilization?
If you need to have your limb stabilized with splints, which are device used to support and immobilize a body part, it’s a job that takes at least two people. One person carefully does the actual positioning of the splint, while another person applies the necessary force to get the splint on securely. If the splint needs to go on a larger area, like your entire leg, you may need some additional help to make sure everything is done safely.
Placing a splint across your entire leg, from your thigh to your ankle, might be painful. So doctors use methods like analgesia (drugs that reduce pain) and sedation (medicine that makes you sleepy and relaxed) to make this process more comfortable for you. This procedure may need other doctors to help with, along with nurses and potentially respiratory therapists (who help make sure you’re breathing well) or other support staff if they’re available.
Preparing for Femur Immobilization
Preparing all the necessary tools and having extra staff to assist is often all you need to set a splint for a limb. Splints are a type of immobilization device that help keep an injured area from moving so it can heal properly. An extremity refers to an arm or a leg.
If a more invasive procedure is required, like placing pins inside the body for stabilization, then more preparation is needed. This involves thoroughly cleaning the skin using a sterile (free from germs) technique to prevent infection. If possible, a completely germ-free environment should be set up and, to ease any discomfort or pain, painkillers and sedatives would be given.
It’s also important that the health of the nerves and blood vessels in the affected limb is checked before any immobilization device like a splint or cast is put in place. This is called a neurovascular exam. This exam should also be conducted any time the limb is moved, or the immobilization device is changed to a different one.
How is Femur Immobilization performed
A traction splint is a device used to pull on a body part. Most traction splints involve an ankle harness and some type of cord or rigging to create the pull. Before placing it, it’s crucial to check the patient’s current nerve and blood circulation status. This is done through a neurovascular exam. Any unusual findings should be noted, and care should be taken to ensure that the splint doesn’t make these conditions worse. After the splint is placed, this nerve and blood circulation check should be repeated regularly to spot and treat any changes quickly.
Each splint comes with specific instructions for use, but the essential steps are usually attaching the splint to the patient and applying the pull. This can be done in two basic ways. Many splints position the injured limb in its natural position. However, some use a different angle, with the hip bent at 30 to 45 degrees and the knee bent between 60 to 90 degrees.
Possible Complications of Femur Immobilization
If a splint is not put on correctly, it can cause problems because the straps or hard parts of the splint can injure the area. Once the injured part of the body has been secured with a splint, it is important to continuously check the blood flow, feeling, and movement in the area below the splint. This check needs to be done frequently because there could be changes especially soon after the injury when swelling increases. These checks are made to prevent complications from happening.
Swelling can also cause problems in the area around the splint and further away from it. Because of this, the person needs to be watched closely for compartment syndrome, a serious condition caused by high-pressure buildup from internal bleeding or swelling of tissues.
In instances where metal pins are used in the thigh or lower leg (transfemoral/transtibial pins), there can potentially be local infection or bleeding. To prevent these complications, the person caring for the patient should follow the proper step-by-step procedure in caring for the pin site.
What Else Should I Know About Femur Immobilization?
When you break your femur, which is the long bone in your thigh, the first step a doctor usually takes is to immobilize, or hold still, your leg. This is a temporary step until they can fix the break properly. The main aim is to prevent the injury from getting worse. The reason this is important is because a broken femur can create sharp pieces of bone that can cut nerves and blood vessels running along the bone. There’s also a chance of causing further damage if the bone gets dislocated.
It’s the medical team’s job to try to avoid these extra problems as much as possible, as they can be really dangerous. For example, if a piece of bone cuts the major artery in your thigh, it can cause serious bleeding and damage to the rest of your leg, including conditions like ischemia (lack of blood supply) and compartment syndrome (a painful condition caused by pressure build-up from internal bleeding or swelling of tissues).
From your point of view as a patient, having your leg properly immobilized can greatly reduce your pain and lessen the need for painkillers. It can also help control painful muscle spasms, making you more comfortable and reducing the quantity of painkillers required.
