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Fractures

By Neil Daniels

What is a Fracture

A fracture is where a bone is cracked of broken, Although with children a bone may bend or splinter this is called a “greenstick” fracture.

Causes Of Fractures• Direct force – Is when a bone is

broken at the area of impact. E.G (Picture to your right)

• Indirect force – Is when a bone is broken in a area away from the point of impact. This happens because the force is transferred from the point of impact then along the limb until the force comes across a weak bone or a weak spot in a bone. E.G If someone were to fall off a chair and stretch out one arm to stop them from falling, the point of impact would be the hand the force would then travelled up the arm until it was stopped by the collarbone resulting in a fractured collar bone.

• Abnormal muscular contraction – A fracture caused by a sudden contraction of a muscle. This can cause pieces of bone being pulled away from where the muscle is attached. E.G Electrocution

Direct Force – Eduardo suffered a double compound fracture. Its ok he is fine now and is still producing many fine goals.

Slings Slings are used to

provide support for a fractured arm, hand, collar bone and ribs there 3 different types of slings each with a different purpose. Slings require a triangular bandage but if none are available then you must improvise.

Types of slings• Arm sling – Arm slings hold the arm across the chest at a right

angle. They are used to provide support to a fractured forearm and hand and when there is no external bleeding. Although they are not suitable for when moving a casualty as they don’t provide the tightness that an elevation sling can provide. Use an elevation sling if you are going to move the casualty. Do not use for compound fractures.

• Elevation sling – Elevation slings hold the arm across and up the front of the chest. They can be used for forearm, humorous, and hand fractures. They must be used if there is external bleeding on the injured limb, when the casualty is being moved and when there is a shoulder, collar bone and rib fracture. Do not use for compound fractures

• Collar and cuff sling – Collar and cuff slings hold the arm across and up in front of the chest. They are used in cases where pressure cannot be put on the elbow. They can be used for forearm, humorous, and hand fractures. These slings can be used for compound fractures as they do not put pressure on the bone sticking out of the arm. Although if the arm cannot be moved without the casualty feeling pain or discomfort then don’t use a sling wait for an ambulance to come to you.

Splints

Splints are used to immobilise a fractured limb by holding the casualty's limbs still while being transported. Splints are only necessary when transporting a patient. Commercial splints are only to be used by specialist medical personal. Improvised splints must be used by other people splints can be easily improvised using items such as wood, folded newspaper, rolled up towel, and other flat hard objects. Splints have to be comfortable, firm and long enough to extend past the joints above and bellow the fracture site. With leg fractures the uninjured leg can be used as a splint.

Types of Fractures

• Simple fracture (closed fracture)

• Compound fracture (open fracture)

• Complicated fracture

• ‘Greenstick’ fractures

Simple Fracture

Simple fractures or closed fractures are those in which the surface of the skin is not penetrated by the bone

Recognition • Pain near or at the site of fracture.• Difficulty or impossible to move the injured part.• Loss of power.• Swelling.• Discolouration. • Deformity.• Irregular movement of the injured part.• Crepitus – grating of the ends of a broken bone (Never test for

crepitus).• Sound of bone snapping (at the moment of the accident).• Outline of the bone can be easily felt. • Tenderness.• Pain moving fingers and toes.• Shock.

Management1. Calm and reassure casualty.2. Stop movement – the main objective when managing fractures is to prevent movement of the

fractured bone/bones. By getting the casualty, a bystander or yourself to hold the fractured limb in a position of most comfort. This reduces pain and prevents further injury.

3. Immobilise joints – immobilise the joints on the injured limb above and bellow the fracture using immobilisation. Immobilisation is done by using slings, bandages and splints in order to prevent the bone from moving. If you are unable to obtain first aid equipment you must improvise. E.g. using your shirt as a bandage or a sling or using newspaper as a splint. (only if able)

4. Check circulation (after Immobilisation) – Check the circulation of the fractured limb by checking circulation in the nails, radial pulse or check colour and warmth of hands and feet. If Circulation is week or stoped reapply bandage, sling or splint.

5. Check nerve function – check for affected nerve function. Ask the casualty if they feel sensation in the limb or if they can feel their fingers or feet. If no nerve function is present then seek medical assistance.

6. Ice pack – If you have an ice pack near the casualty apply it to reduce pain and swelling.7. Elevation– elevate the affected limb above the heart to reduce pain and swelling. (only If

able) 8. Shock – If patient is in shock treat for shock.

DO NOT!• Force a fractured limb into a position especially if casualty is

complaining of pain or discomfort.• If a fractured limb is deformed don’t realign into a position.• Only use commercial splints if you know how to correctly apply

them if you are unable to use commercial splint use a improvised splint.

• Move the limb into a position where the casualty is feeling discomfort.

Compound fracture Compound fractures or

open fractures are those where the surface of the skin is broken by the bone. These fractures are very dangerous because they result in blood loss, are prone to infection and the broken bone can cause damage to nerves, muscles, tendons, ligaments and blood vessels.

Recognition

• Seeing the broken bone.• Bleeding at the site of fracture.• Difficulty or impossible to move the injured part.• Severe pain at the site of fracture.• Deformity. • Loss of power.• Irregular movement of the injured part.• Sound of bone snapping (at the moment of the accident).• Tenderness.• Pain moving fingers and toes.• Swelling.• Discolouration.• Shock.

Management

1. Call an ambulance.2. Calm and reassure the casualty.3. Control bleeding - control any bleeding around the fracture site. Do not apply pressure to the protrusion.

Apply a donut dressing around the fracture site, using a roller bandage to secure donut. Put pressure on the donut above and bellow the fracture site. Do not put pressure directly on the fracture site the fracture site.

4. Stop movement – the main objective when managing fractures is to prevent movement of the fractured bone/bones. By getting the casualty, a bystander or yourself to hold the fractured limb in a position of most comfort. This reduces pain and prevents further injury.

5. Check circulation - Check the circulation of the fractured limb by checking circulation in the nails, radial pulse or check colour and warmth of hands and feet. If no circulation is present then seek urgent medical assistance.

6. Immobilise joints – Firstly make sure that a donut dressing is applied around the fracture site then stabilise the donut with a roller bandage. Immobilise the joints on the injured limb above and bellow the fracture using immobilisation. Immobilisation is done by using slings, bandages and splints in order to prevent the limb and the bone from moving. Make sure that you don’t cover the fracture site with a sling, bandage or splint, a collar and cuff bandage is the most appropriate for compound fractures because they don’t usually cover the fracture site. If you are unable to obtain first aid equipment you must improvise. E.g. using your shirt as a bandage or a sling or using newspaper as a splint. (only if able)

7. Check circulation (after Immobilisation) – Check the circulation of the fractured limb by checking circulation in the nails, radial pulse or check colour and warmth of hands and feet. If Circulation is week or stoped reapply bandage, sling or splint.

8. Check nerve function – check for affected nerve function. Ask the casualty if they feel sensation in the limb or if they can feel their fingers or feet. If no nerve function is present then seek medical assistance.

9. Elevation– elevate the affected limb above the heart to reduce pain and swelling. (only If able)10. Shock – if patient is in shock treat for shock.

Sometimes with compound fractures its better control bleeding first and check circulation and then to just leave the fracture as you found it only if you are in a populated area where an ambulance is easily accessible. If you are in a rural area and you have to move the casualty only then you must you manage it.

DO NOT!• Apply direct pressure on the fracture site.• Touch the fracture site leave that to the professionals.• Apply ice packs on the fracture site.• Force a fractured limb into a position especially if casualty is

complaining of pain or discomfort.• If a fractured limb is deformed don’t realign into a position.• Only use commercial splints if u know how to correctly apply

them if you are unable to use commercial splint use a improvised splint.

• Move the limb into a position where the casualty is feeling discomfort.

Complicated fracture

• Complicated fractures are fractures in which the broken bone or fragments of a broken bone cause damage to organ, or major blood vessel. E.G broken ribs can sometimes cause damage to the lungs this is called flail fragment.

Recognition

• Pain in soft lower torso reign (organ damage). • Difficulty breathing (damaged lungs).• Coughing up blood (damaged lungs).• Difficulty or unable to move fingers or toes (nerve damage).• Loss of sensation (nerve damage).• Blood coming out from the mouth (organ damage).• Nausea• Shock.• Discolouration.

Management

1. Call an ambulance.

2. DR ABCD.

3. Calm and reassure the casualty.

4. Control external bleeding as you would with a compound fracture (blood vessel damage).

5. Stop movement to injured part of the body.

6. Keep them in a position of most comfort.

7. Monitor vitals until medical help arrives.

Bibliography

• Haines, J. (2006). Emergency First Aid. Medic Media International: Upwey, Victoria.

• Brasch, N. (2004). The Family Emergency Handbook. Hinkler Books: Dingley, Victoria.

• Lippman, J. and David, N and Royal Life Saving Society. (2006). First Aid: a training guide to the management of emergencies. J L Publications: Ashburton, Victoria.