A fracture is a complete or partial breakage of a bone. Fractures may be:
- Simple, where the broken ends of the bone do not cut open the skin
- Compound, where the broken end of the bone may be in contact with the external air
- Complicated, where in addition to the fracture
an important internal organ may also be injured. A complicated fracture
may also be simple or compound.
Signs and Symptoms of a Fracture
- Pain at or around the site of the fracture.
- Tenderness (pain on gentle pressure) over the area. Do not press hard.
- Swelling over the area with discoloration.
- Loss of normal movements of the affected part.
- Deformity of the limb may be caused. The limb may lose its normal shape and there may be apparent shortening of the limb.
- If, as in the leg bone, the break is just under the skin, the irregular outline of the bone can be felt easily.
- When one end of the broken bone moves against the other, a crackling sound may be heard. This is called crepitus (grating). This should never be elicited by the person giving First Aid.
- Unnatural movements may be felt at the site of
the fracture. This too should never be elicited by the First-Aid provider.
In addition the victim may himself say that he heard the snap of the bone. It is important to compare the injured limb with the normal limb while making an assessment.
Management of Fractures
The aims of First Aid here are:
- To prevent further damage
- To reduce pain
- To make the patient feel comfortable
- To get medical aid as soon as possible
- Fractures often occur along with other injuries. So the rescuer must assess for other injuries and decide which of them requires care on priority. Heavy bleeding is more urgent and requires higher priority care over a fracture.
- If there is no danger to life then temporary attention to the fracture is often sufficient.
- Handle the patient very gently. Avoid all unnecessary movement.
- Treat for shock if present.
- If the broken ends of the bones show out, do not wash the wound or apply antiseptics to the end of the bone.
- Do not handle the fracture unnecessarily.
- Never attempt to reduce the fracture or to bring the bones to the normal position.
- Stabilise and support the injured part so that no movement is possible. This stops further injury and helps to control the bleeding.
- Immobilise the fracture area and the joints on
both sides of the fracture site (above and below) by using bandages or
by using splints wherever available. It is essential that the rescuer be
familiar with the use of bandages and splints.
A: Using Bandages
Usually it is enough to use the other (uninjured) limb or the body of the victim as the splint. The upper limb can be supported by the body, and the lower limb by the other limb provided that also is not fractured. Most fractures except those of the forearm can be immobilised in this manner:
B: Using Splints
- Do not apply bandage over the area of the fracture.
- The bandaging should be firm so that there is no movement of the fractured ends but should not be too tight as blood circulation to the affected area could be reduced. If there is further swelling of the injured area, the bandage may be too tight and therefore may need to be loosened.
- Always place padding material between the ankles, knees and other hollows if they have to be tied together so that when the limbs are bound together they are comfortable and steady.
- If the patient is lying down, the bandage should be passed through the natural hollows like the neck, the lower part of the trunk, knees, just above the ankles etc., so that the patients body is not jarred.
- Always tie the knots on the sound side.
Splints are used only when necessary expertise is there.
- A splint is a rigid piece of wood or plastic material or metal applied to a fractured limb to prevent movement of the broken bone.
- Reasonably wide splints are better than narrow ones.
- Splints should be long enough so that the joints above and below the fractured bones can be made immobile.
- The splints should be well padded with cotton or cloth so as to fit snugly and softly on the injured limb.
- Splints are best applied over the clothing.
- In an emergency, splints can be improvised using a walking stick, an umbrella, a piece of wood, a book or even a firmly folded newspaper.
- Use of splints becomes obligatory only when both
legs or both thigh bones are broken.
Fractures involving the back (vertebral column) require special care. In such cases, the victim should not be allowed to get up. Further, movement must be avoided as much as possible and emergency medical help must be sought.