# A 45-year-old client with a history of osteoporosis is admitted to the emergency department after falling at home and sustaining a displaced femoral neck fracture. The client is scheduled for surgical repair. Which nursing intervention should be the priority during the preoperative period?

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## 문제

A 45-year-old client with a history of osteoporosis is admitted to the emergency department after falling at home and sustaining a displaced femoral neck fracture. The client is scheduled for surgical repair. Which nursing intervention should be the priority during the preoperative period?

## 보기

1. Encourage early ambulation to prevent complications
2. Maintain the affected leg in proper alignment and immobilization **✔ 정답**
3. Apply ice packs to the fracture site every 2 hours
4. Perform passive range of motion exercises to prevent stiffness

**정답: 2**

## 해설

Maintaining proper alignment and immobilization is key to prevent further displacement and complications before surgery. Other options could worsen the fracture or are not priorities.

## 심화 해설

Understanding the Priority: Preoperative Care for a Hip Fracture

For a client with a displaced femoral neck fracture, the immediate preoperative period is a time of significant physiological stress and risk. The fracture itself creates a state of inflammation, immobility, and severe pain, which can rapidly destabilize a patient, especially one with a history of osteoporosis [1]. The priority nursing intervention must directly address the most immediate threat to tissue integrity and systemic stability before surgery can safely occur.

Why Maintaining Alignment and Immobilization is the Priority

The correct answer is to maintain the affected leg in proper alignment and immobilization. A displaced fracture means the bone fragments are no longer in their anatomical position. Any movement of the fractured limb can cause the bone ends to grind against each other or shift further. This leads to three critical consequences that directly connect to the rationale in the provided evidence:

1.  Exacerbation of Pain and Inflammation: The abstract highlights pain and inflammation as core components of the hip fracture condition [1]. Movement at the fracture site triggers intense nociceptor stimulation, worsening pain and driving a systemic inflammatory response. Immobilization is the primary non-pharmacological method to break this cycle, providing comfort and physiological stability.

2.  Prevention of Further Soft Tissue and Neurovascular Injury: Unstable bone fragments are sharp and can lacerate surrounding muscles, blood vessels, and nerves. The femoral neck is in close proximity to the medial and lateral circumflex femoral arteries, which supply blood to the femoral head. Further displacement can compromise this already tenuous blood supply, increasing the risk of avascular necrosis. Proper alignment and immobilization protect the neurovascular bundle and soft tissue envelope from iatrogenic injury.

3.  Optimization for Surgical Timing: The evidence supports early surgical management, typically within 2 days, to mitigate morbidity and mortality [1]. A key component of preoperative optimization is ensuring the limb is in a stable, neutral position. This minimizes tissue edema and hematoma formation, making the surgical field more manageable for the surgeon and reducing intraoperative complications. Buck's traction, a common method of temporary immobilization, applies a gentle pulling force to maintain alignment and reduce muscle spasm, directly facilitating this goal.

Analysis of Incorrect Options in the Preoperative Context

- Option 1: Encourage early ambulation to prevent complications. This is a critical postoperative goal, not a preoperative one. The abstract identifies immobility as a core problem [1], but the solution before surgical fixation is not ambulation. Attempting to bear weight on a displaced, unstable fracture would cause severe pain, worsen displacement, and risk catastrophic neurovascular damage. Early mobilization is contraindicated until the fracture is surgically stabilized.

- Option 3: Apply ice packs to the fracture site every 2 hours. While cold therapy is a useful adjunct for pain and swelling, it is not the priority intervention. Ice does not stabilize the fracture or prevent the severe complications of bone fragment movement. It is a comfort measure that can be implemented after the limb is properly immobilized. The systemic condition of the patient, driven by the unstable fracture, takes precedence over localized cryotherapy.

- Option 4: Perform passive range of motion exercises to prevent stiffness. This intervention is contraindicated in the preoperative period for a displaced fracture. Moving the joint through its range of motion would directly move the fracture site, causing the same risks of pain, tissue injury, and neurovascular compromise. Range of motion exercises are a vital part of rehabilitation but are only safe to perform after surgical fixation has provided stability to the bone fragments.References (research sources)

- [1]Management and optimisation in the preoperative phase for patients with a fractured hip.Research articleMeermans G, van Egmond JC. (2026) · DOI: 10.1530/eor-2026-0044

## 임상 시나리오

Preoperative Hip Fracture StabilizationPriority Nursing Action for Displaced Fractures
For a displaced femoral neck fracture, the immediate preoperative priority is immobilization and alignment. Any movement can cause bone fragments to damage surrounding soft tissue, nerves, and blood vessels.

Maintain the leg in a neutral, stable position using buck's traction or pillows as ordered. This reduces pain and prevents muscle spasm by eliminating friction between bone ends.

CautionNever perform passive range of motion or encourage ambulation on a displaced fracture before surgical fixation. This can cause fat embolism or convert a closed fracture to an open one.

## 핵심 개념

- **Avascular Necrosis (AVN)** — Death of bone tissue due to a lack of blood supply; a major complication of femoral neck fractures if the retinacular arteries are damaged.
- **Displaced Femoral Neck Fracture** — A break in the femur just below the ball of the hip joint where the bone fragments have moved out of their normal alignment.
- **Retinacular Arteries** — The primary blood vessels supplying the femoral head, which are at high risk of injury from displaced hip fractures.
- **Preoperative Immobilization** — Stabilizing the injured extremity using traction, splints, or positioning to prevent movement of bone fragments before surgical repair.

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