For pediatric patient see Femur fracture (peds)
- Despite good care, proximal fracture 30-day all cause mortality is 22% and grows to 36% at one year
- Mid-shaft femur fracture (all subtrochanteric)
- History of trauma
- Pain, point tenderness, deformity
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
- Plain xrays of femur
- Pain control in ED with femoral nerve blocks.
- Most fractures, including all displaced, are treated with ORIF
- Exception is isolated trochanteric fracture often does not require surgery
- See individual pages for further discussion
- Type and cross/screen for patients at higher risk of hemorrhage:
- Age > 75 yrs
- Initial hemoglobin < 12
- Peritrochanteric fracture
- Generally requires admission for operative repair
- Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.
- Reavley P, et al. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2014 Nov 27.