04/11/2022
To TQ or not to TQ femur fractures? Wisdom from a person that knows TQs and ortho.
Assuming a closed femur fracture, keep in mind that a closed fracture does not rule out major vessel damage, but in m experience, the probability is low, especially with intact distal pulses.
If the leg is placed into traction, then the TQ is not necessary assuming hemodynamic stability. With traction applied, the femur is pulled to length. There will be some internal bleeding, but the skin will not be able to stretch excessively due to the fact that the femur is out to length. Hence, there will be an internal tamponade.
If traction is not available, then it is possible to lose 3 L of blood into the thigh. As the blood loss increases, the thigh expands causing the fractured femur to shorten. Because of this continuing cycle, the internal blood loss can be life threatening.
Since traction is usually not readily available or quickly applied, then my feeling is to apply the TQ high and tight. If at some point treatment is available, the TQ could be removed (PCC situation) while the patient is reassessed.