In a patient neck of the femur fractured. Position of the leg should maintain in?

NORCET -4 , 2023

Medical & Surgical Nursing

Medium

Appeared in: NORCET -4 , 2023

Explanation

A fracture of the neck of the femur is an intracapsular hip fracture, meaning it occurs within the joint capsule.
The classic presentation is a shortened and externally (laterally) rotated leg.
The external rotation is limited to less than 45 degrees because the intact joint capsule and the strong iliofemoral ligament physically restrict the distal bone fragment from rotating further outward.

Option B: This degree of rotation is characteristic of an extracapsular (intertrochanteric) fracture, where the joint capsule does not limit the rotation.
Option C: Hip fractures cause external rotation due to the pull of external rotator muscles and gravity on the detached femoral shaft.
Option D: This is incorrect for two reasons: the direction of rotation is wrong (it should be external), and the degree is excessive.

Visual 1: Diagram - A comparison showing the leg position in an intracapsular fracture (shortened, <45° external rotation) versus an extracapsular fracture (shortened, >45° external rotation).
Visual 2: Anatomical Illustration - The hip joint, highlighting the capsule and the iliofemoral ligament to show why rotation is restricted in a femoral neck fracture.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical assessment and signs of hip fractures, specifically differentiating between intracapsular and extracapsular types to guide bedside assessment, documentation, and the next nursing action.
Recognizing the specific position of the leg is a crucial initial assessment skill for nurses to quickly suspect the type and location of a hip fracture, guiding immediate care.
Nursing care involves immobilizing the limb (e.g., with trochanter rolls) to prevent further rotation, which minimizes pain, reduces the risk of further vascular damage, and maintains alignment pending surgical intervention.
What if? If the patient's leg was shortened and INTERNALLY rotated, the priority diagnosis would shift from fracture to posterior hip dislocation, which is a neurovascular emergency requiring immediate reduction to prevent avascular necrosis and nerve damage.

How to Approach the Question

First, identify the keywords in the question: 'neck of the femur fractured' and 'position of the leg'.
Recall that a neck of femur fracture is an intracapsular fracture.
Remember the two classic signs of a hip fracture: shortening and external rotation of the affected leg. This immediately eliminates the 'internal rotation' options.
Differentiate between the two 'external rotation' options by recalling the specific rule: intracapsular fractures have limited rotation (less than 45 degrees) due to the intact joint capsule, while extracapsular fractures have more pronounced rotation (more than 45 degrees).
Select the option that matches the presentation of an intracapsular (neck of femur) fracture.

Concept Tested & Keywords

Concept Tested: Clinical assessment and signs of hip fractures, specifically differentiating between intracapsular and extracapsular types.
Stem keywords: neck of the femur fractured, position of the leg
Lead-in keywords: maintain in
Negative lead-in flag: false

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