Broken bones, or fractures, are common injuries amongst children and adults. A fracture occurs when excessive force is applied to a bone resulting in a break. Let’s look at the main types of fracture you might encounter.
A closed fracture occurs when the bone is broken but does not cause a break in the skin. The majority of fractures are closed. If the bone does break through the skin, this is known as an open fracture.
Open fractures are more serious as there is a significant risk of infection in the exposed bone. Open fractures can be missed as the bone may not always be easily visible in the wound. Any wound overlying a fracture should be suspected to be caused by an open fracture.
Complicated fractures occur when the broken bone damages blood vessels or nerves near the fracture site. These fractures require urgent specialist medical treatment in order to reduce the risk of long-term complications such as permanent nerve damage.
Signs and Symptoms of a Broken Bone
- Pain
- Loss of movement
- Angulation of the limb
- Swelling
- Tenderness
- Irregularity
- Crepitus (a cracking or grating sound)
These signs and symptoms can be remembered by using the acronym PLASTIC. It is easier to assess for angulation or irregularity in a limb by comparing the suspected fracture to the other unaffected limb.
First Aid Treatment for a Broken Bone
1. Assess the Situation
- Ensure Scene Safety: Check that the area is safe before approaching the injured person.
- Determine the Injury Severity: Look for signs of a broken bone, which may include severe pain, swelling, visible deformity, bruising, or an unusual angle or protrusion (an open or compound fracture). Also, check if the bone is sticking out through the skin. If the injury involves the head, neck, back, or if there is suspected spinal involvement, extra caution is needed.
- Check Responsiveness and Circulation: Ask the person how they feel. Carefully check blood circulation beyond the injury (for example, by looking for a normal color and feeling a pulse in a distal body part). Signs like numbness or tingling may indicate a compromised circulation.
2. Stop Any Bleeding
- Apply Pressure: If the injury is bleeding, use a sterile bandage or a clean cloth to apply gentle, direct pressure to control the bleeding.
- Avoid Using a Tourniquet (unless Absolutely Necessary): A tourniquet only in severe, life-threatening bleeding when no other options are available, as improper use can cause further damage.
3. Immobilize the Injured Area
- Avoid Movement: Do not try to realign or force the broken bone back into place. Movement can worsen the injury.
- Splinting: If you are trained in splinting and if medical help is delayed, use a splint to immobilize the injured limb. The splint should extend beyond both ends of the fracture.
- You can use a rigid item (such as a board, rolled-up newspaper, or a firm stick) and secure it with cloth or a belt.
- Place soft padding between the injured limb and the splint to reduce pressure and provide cushioning.
- Secure the Area: Immobilize not only the injured part but also the joints above and below the fracture site to limit unnecessary movement.
4. Manage Pain and Swelling
- Cold Compress: Wrap an ice pack or a bag of ice cubes in a cloth, and gently apply it near (but not directly on) the injured area for up to 10-15 minutes at a time. This helps reduce swelling and pain. Avoid placing ice directly on the skin.
- Comfort Measures: Keep the patient calm and reassure them that help is on the way.
5. Monitor for Signs of Shock
- Watch for Shock: If the person feels faint, is sweating excessively, or shows signs like pallor and rapid breathing, lay them down with the head slightly lower than the torso if no spinal injury is suspected. Elevate the legs if possible, and cover them with a blanket to maintain warmth.
6. Seek Professional Medical Help Immediately
- Call Emergency Services: If the broken bone is severe (especially if it is an open injury, involves excessive bleeding, or the patient has other concerning symptoms such as numbness or loss of movement), call 911 (or your local emergency number) without delay.
- Transport Considerations: Even if the fracture doesn’t seem severe, it’s important that the patient is evaluated by a healthcare professional as soon as possible for imaging studies and definitive treatment.
Additional Points
- Do Not Attempt to Straighten the Bone: Avoid trying to reposition the bone yourself, as this can cause further damage to surrounding tissues, including vessels and nerves.
- Keep the Injury Clean: For open fractures, cover the injury with a sterile dressing or a clean cloth to minimize the risk of infection. Avoid immersing the injury in water.
- Gather Information: If possible, note down the details of how the injury occurred, as this information can be helpful to medical professionals during treatment.
Prevention
- Strengthen Bones Through Nutrition
- Exercise for Bone Density and Balance
- Fall-Proof Your Environment
- Protective Gear for Sports and Work
- Regular Health Screenings
REFERENCES
- Overview of fractures. Merck Manual Professional Version. http://www.merckmanuals.com/professional/injuries-poisoning/fractures/overview-of-fractures.
- Broken bones. American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/broken-bones.
- Broken arm or wrist. National Health Service. https://www.nhs.uk/conditions/broken-arm-or-wrist/.
- Mayo Clinic Staff. (2015, March 19). Fractures (broken bones): First aid
http://www.mayoclinic.org/first-aid/first-aid-fractures/basics/art-20056641 - Linda Hepler, First Aid for Broken Bones and Fractures, Updated on July 9, 2017, https://www.healthline.com/health/first-aid/broken-bones
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