“A patient has a fractured neck of femur. To prevent further displacement, the nurse should position the leg to avoid which movement?”

Appeared in: NORCET -4 , 2023

Explanation

A fracture of the femoral neck is an intracapsular fracture, meaning it occurs inside the hip joint capsule.
The intact joint capsule, particularly the strong iliofemoral ligament, acts as a restraint.
This restraint prevents the fractured leg from rotating freely, limiting the degree of external rotation to less than 45 degrees.
The leg is also typically shortened due to muscle pull.

Why Other Options Were Wrong

Option B: External rotation greater than 45 degrees is a sign of an extracapsular (intertrochanteric or subtrochanteric) fracture, where the joint capsule is not intact to limit rotation.
Option C: Hip fractures cause external rotation, not internal rotation. The pull of the short external rotator muscles on the femur is unopposed after the fracture.
Option D: As with the other internal rotation option, this is incorrect because hip fractures lead to external rotation.

Related Visual

$A diagram comparing two patients. One with an intracapsular fracture showing the leg externally rotated less than 45 degrees. The other with an extracapsular fracture showing th...$

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical assessment and signs of a femoral neck fracture to guide bedside assessment, documentation, and the next nursing action.
A nurse's initial assessment of limb position is a critical non-invasive tool to suspect the type and location of a hip fracture before imaging is complete.
Immediate nursing priorities for a suspected hip fracture include immobilizing the affected limb (e.g., with pillows or a trochanter roll), managing pain, and performing frequent neurovascular checks on the affected leg (checking pulse, color, temperature, sensation, and movement).
What if? If the patient's leg was externally rotated to 90 degrees with the side of the foot flat on the bed, the nurse should suspect an extracapsular (intertrochanteric) fracture, which is often associated with greater blood loss and instability.

How to Approach the Question

First, identify the key information in the question: the injury is a 'neck of the femur fracture'.
Recall the classification of hip fractures. A femoral neck fracture is 'intracapsular' (inside the joint capsule).
Think about the anatomy. The hip joint capsule is strong and remains intact in this type of fracture.
Deduce the clinical sign. The intact capsule will limit how much the leg can rotate externally. This results in rotation, but it is limited (less than 45 degrees).
Eliminate the other options. Internal rotation is incorrect for fractures, and significant external rotation (>45 degrees) is seen in extracapsular fractures.

Concept Tested & Keywords

Concept Tested: Clinical assessment and signs of a femoral neck fracture.
Stem keywords: neck of the femur fracture, position of the leg
Lead-in keywords: should maintain in
Negative lead-in flag: false

Question ID

QjKT26LCJ4km2SOdUjkUAo

Reference Book

E6 Osteology InderbirSingh 5e pp. 135-137, 136-138

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