Essex and Herts Air Ambulance: a focused case series for pre-hospital practice Case 3: a femoral shaft fracture

The femur is the longest bone in the human body and is surrounded by a dense and vascular cylindrical sheath of soft tissue. Femoral fractures are often the result of high-energy traumatic injuries and result in pain, blood loss and immobility of the affected leg. General principles of acute management include analgesia, assessment of the patient for associated injuries and restoration of anatomical alignment of the leg. Assessment and documentation of the neurovascular function in the foot distal to the fracture is essential. Haemorrhage from a femoral fracture can be extensive, even more so if the fracture is open. Control of further blood loss and attention to the patient's cardiovascular status is mandatory. We report the case of a 23-year-old woman who was involved in a pedestrian-versus-car incident and sustained an isolated right femoral fracture. Scene and patient assessment are discussed along with early management principles including analgesia and traction. We also discuss where an extended car...