Question

Following a high-velocity motorcycle collision, a 26-year-old male driver is evaluated in the trauma resuscitation unit. He was intubated at the scene for a Glasgow Coma Scale score of 7. On arrival, his temperature is $35.2^\circ\text{C}$ ($95.4^\circ\text{F}$), blood pressure is $85/50 \text{ mm Hg}$, and heart rate is $132\text{/min}$. Primary survey reveals decreased breath sounds on the right. A tube thoracostomy is performed, yielding a large rush of air and $50 \text{ mL}$ of blood; his oxygen saturation improves to 94%, but his blood pressure remains $90/55 \text{ mm Hg}$ despite the rapid infusion of $2 \text{ L}$ of warmed crystalloids. The focused assessment with sonography for trauma (FAST) is negative. A pelvic radiograph shows no fractures. Examination of the extremities reveals a grossly deformed and swollen right thigh with intact overlying skin. Dorsalis pedis and posterior tibial pulses are palpable and symmetric. A portable chest radiograph shows bilateral patchy infiltrates and a right-sided chest tube in good position. A radiograph of the right femur confirms a comminuted diaphyseal fracture. Arterial blood gas analysis reveals a pH of $7.21$, $\text{PaCO}_2$ of $48 \text{ mm Hg}$, $\text{PaO}_2$ of $65 \text{ mm Hg}$, and a lactate level of $5.2 \text{ mmol/L}$. Which of the following is the most appropriate next step in the management of this patient's femur fracture?