# A nurse is assessing a client with a suspected fracture of the femur. Which assessment finding would be most indicative of a femoral fracture? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540975 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a client with a suspected fracture of the femur. Which assessment finding would be most indicative of a femoral fracture? ## 보기 1. Shortening and external rotation of the affected leg **✔ 정답** 2. Numbness and tingling in the affected leg 3. Swelling and bruising around the affected leg 4. Bruising and swelling on the lateral knee **정답: 1** ## 해설 Shortening and external rotation are classic signs of a femoral fracture due to muscle spasm and displacement. Other options are less specific or indicate complications. ## 심화 해설 Understanding the Clinical Presentation of a Femoral Fracture When a femur fractures, the powerful muscles surrounding the thigh play a significant role in the characteristic deformity observed. The assessment finding most indicative of a femoral fracture is shortening and external rotation of the affected leg. This classic presentation is a direct result of the unopposed muscle forces acting on the fracture fragments. The proximal fragment is typically flexed and abducted by the iliopsoas and gluteal muscles, while the distal fragment is pulled proximally (causing shortening) and externally rotated by the adductor muscles. This biomechanical consequence creates a visible and palpable deformity that is a hallmark sign for nurses during the initial trauma assessment. While the provided reference material focuses on a specific and rare type of distal femoral fracture called a Hoffa fracture, it reinforces the broader principle that femoral fractures present with significant anatomical disruption. The case report details a coronal plane fracture of the lateral femoral condyle, an injury that is "often overlooked in radiographs" . This highlights a critical nursing responsibility: a thorough physical assessment is paramount, as diagnostic imaging alone may not always reveal the full extent of the injury. The nurse’s finding of a shortened, externally rotated leg is a gross, clinical indicator of a fracture that requires immediate stabilization and intervention, often preceding and guiding the definitive radiographic diagnosis. The other options represent findings that are less specific to a femoral shaft or proximal fracture. Numbness and tingling are neurological symptoms that suggest nerve injury or compartment syndrome, which are potential complications but not the primary, defining deformity of the fracture itself. Swelling and bruising are general signs of soft tissue trauma and inflammation present in almost all fractures, making them non-specific. Bruising and swelling on the lateral knee is more localized and could be associated with a tibial plateau fracture, a ligamentous injury, or a distal femoral condyle fracture like the Hoffa fracture described in the source . However, it does not represent the classic, whole-limb deformity caused by the displacement of a major long bone fracture. ## 임상 시나리오 Clinical Guide: Initial Assessment of Suspected Femoral Fracture When assessing a patient with a suspected femoral fracture, the priority is to identify the classic deformity while simultaneously evaluating for life-threatening complications. The hallmark sign is a shortened and externally rotated leg, caused by the unopposed pull of the iliopsoas and adductor muscles on the fracture fragments. This finding alone should prompt immediate stabilization. **Key Assessment Sequence:** - **Inspection & Palpation:** Visually confirm the shortening and external rotation. Note any open wounds, significant swelling, or bruising. Palpate for crepitus, but avoid unnecessary manipulation. - **Neurovascular Status:** Immediately assess the 6 Ps (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) distal to the injury. Document dorsalis pedis and posterior tibial pulses, capillary refill, sensation, and motor function. Compartment syndrome is a critical risk. - **Hemorrhage Control:** A femoral shaft fracture can result in significant blood loss (up to 1-2 liters) into the thigh. Monitor for signs of hypovolemic shock (tachycardia, hypotension, pallor). - **Stabilization:** Apply manual traction and splint the limb in the position of deformity to prevent further soft tissue and neurovascular injury. Traction splinting is the definitive pre-hospital and emergency department intervention. **Clinical Pearl:** Do not rely solely on imaging. A Hoffa fracture, a rare coronal plane fracture of the femoral condyle, is often missed on standard radiographs. A thorough physical assessment revealing the classic deformity is your most reliable early indicator of a significant femoral injury. ## 핵심 개념 - **External Rotation Deformity** — A positional abnormality where the limb rotates outward away from the body's midline, commonly seen in femoral fractures due to the pull of the adductor muscles on the distal fragment. - **Iliopsoas Muscle** — A powerful hip flexor that, in a femoral fracture, pulls the proximal bone fragment into a flexed and externally rotated position, contributing to the characteristic deformity. - **Adductor Muscles** — A muscle group on the medial thigh that pulls the distal femoral fragment proximally and externally rotates it, causing the visible shortening and rotation of the leg. - **Femoral Shaft Fracture** — A break in the long, straight part of the femur, often resulting from high-energy trauma and presenting with significant deformity, pain, and potential for substantial blood loss. ## 같은 주제 문제 - [A nurse is assessing a client with a suspected fracture of the femur. 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