Bone fracture: First Aid

A fracture is a break or crack in the bone. Generally, considerable force is needed to break a bone, unless it is diseased or old.

Both direct and indirect force can cause bones to fracture. A bone may break at the point where a heavy blow is received, for example, when struck by a car (direct force). Fracture may also result from a twist or a wrench (indirect force).

A fracture may be stable or unstable. In a stable fracture, the broken bone ends do not move, either because they are incompletely broken or they are jammed together. Such injuries are common at the wrist, shoulder, ankle and hip. Usually they can be gently handles without causing any further damage.

In unstable fracture, the broken bone ends can easily move out of position. As a result there is a risk that they may cause damage to the blood vessels, nerves, and organs. Unstable injuries can occur if the bone is completely broken or the ligaments are torn (ruptured). Such injuries should be handled carefully to avoid further damage.

OPEN AND CLOSED FRACTURES.

In an open fracture, one of the bone ends may pierce the skin surface or there may be a wound at the fracture site. An open fracture carries a high risk of becoming infected.

In a closed fracture, the skin above the fracture is intact. However, bones may be displaced (unstable) and cause damage to other internal tissues in the area. If the bone ends pierce organs or major blood vessels, the casualty may have internal bleeding and suffer shock (see our previous post on shock).

                                                 the above image shows an open fracture.. 

First Aid management of open fracture.

In open fracture, your aim is to prevent blood loss, movement and infection at the site of injury.  And also to arrange removal to the hospital, with comfortable support during transport.

                                           A Splint applied to immobilze a fractured limb

• Put on gloves, if available. Loosely cover the wound with a large, clean, non-fluffy pad or sterile dressing. Apply pressure to control bleeding but do not press on the protruding bone.
• Carefully place clean padding over and around the dressing.
• Secure the dressing and padding with a bandage. Bandage firmly but not so tightly that it impairs the circulation. 
•  Immobilise the injured part and arrange to transport the casualty to the hospital.
• Treat for shock if necessary. Monitor and record vital signs- level of response, pulse and breathing. Check the circulation beyond the bandage regularly.

 CAUTION

•  Do not move the casualty until the injured part is secured and supported, unless she is in danger.
• Do not allow the casualty to eat, drink or smoke, as a general anaesthetic may be needed. 
• Do not press down directly on the protruding bone end. Build up pads of clean, soft, non-fluffy material around the bone until you can bandage over the pads to protect from any pressure.