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Fractures

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Fractures

When a bone breaks it is called a fracture. A bone fracture often occurs due to trauma when a force exerted against a bone is stronger than it can structurally withstand. A fracture can also be caused by an acquired disease of bone such as osteoporosis or by abnormal formation of bone in a disease such as osteogenesis imperfecta (“brittle bone disease”). The most common sites for bone fractures include the wrist, ankle and hip.
Classification of Fractures for First Aiders
Closed Fracture – the broken bone does not penetrate through the skin.
Open Fracture – the broken bone penetrates through the skin, or a wound leads to the fracture site. The risk of infection is higher with this type of fracture.
Complicated Fracture – injuries where the broken bone damages underlying organs or tissues such as the brain (in the case of skull fractures) or chest organs (if a rib breaks). Bones have a rich blood supply and a bad break can result in substantial blood loss.
General Fractures
The following signs and symptoms are relevant for all fractures.

Crepitus (broken bone ends grinding together when moved).

Deformity.

Inability to use the limb, loss of function/power.

May be shortening of the limb (due to muscles under pressure).

Bruising.

Pain.

Swelling.

Pale, cool, clammy skin.

Rapid, weak pulse.

Unnatural movement.

For a suspected bone fracture:

Follow the DRSABCD emergency action plan.

DO NOT move the casualty unless there is an immediate danger, especially in the case of a suspected fracture of the skull, spine, ribs, pelvis or upper leg.

In an emergency situation call 000 for an ambulance.

Control any bleeding by pressing firmly above the bleed site with a clean dressing. If a bone is protruding, apply pressure around the edges of the wound.

For further information on bleeding see ‘Bleeding Management’.

If bleeding is controlled, keep the wound covered with a clean dressing.

DO NOT attempt to straighten broken bones.

For limb fractures, provide support and comfort such as pillows under the lower leg or forearm. However, handle gently and do not cause further pain or unnecessary movement of the broken bone.

Apply a splint to support the limb.

Immobilise the area by applying a sling for arms. Limbs should be immobilised above and below a fracture site to be effective.

If possible, elevate the fractured area and apply a cold pack to reduce swelling and pain.

DO NOT let the casualty eat or drink anything until seen by a doctor, in case surgery is required.

Reassure the casualty.

Monitor the casualty for signs of shock.

Slings Using Triangular Bandages

The purpose of splints and slings is to prevent movement of the fractured bone by immobilising the limb, restricting the movement in the joint above and below the fracture site and reducing the amount of bleeding and further injury.

How to Fold a Triangular Bandage

A triangular bandage can be used as a sling or a bandage.

Fold the triangular bandage in half (apex to the base) and then in half again. This is called a broad fold bandage and can be used for bandaging or splinting of the upper legs.

Fold in half again. This is now a narrow fold bandage and can be used for bandaging or splinting of the lower legs or arms.

Management for Specific Fractures
Fractured Pelvis
Care must be exercised with a suspected fractured pelvis as this injury can have serious complications. The casualty should always be transported by ambulance and not by alternative means unless absolutely necessary.

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance urgently.

If the casualty is conscious, lay them flat on their back with their knees slightly bent, elevate the lower legs slightly and support if possible (remember all unconscious casualties should be placed on their side).

Remove everything from the casualty’s pockets and give to relatives or friend.

Immobilise the legs by placing a broad fold bandage around the thighs and a narrow fold bandage around the ankles.

Support both hips with folded blankets on either side.

Discourage the casualty from urinating.

Treat the casualty gently, as they could have further fractures of the legs or internal injuries.

DO NOT let the casualty eat or drink anything until seen by a doctor, in case surgery is required.

Reassure the casualty.

Monitor the casualty for signs of shock.

Fractured Collar Bone (Clavicle) and Dislocated Shoulder

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance urgently.

Check for warmth or pulse to the hand on the injured side; if no circulation gently adjust the position of the limb until circulation returns. This should only be done with great care and if the arm is showing signs of insufficient circulation i.e. skin is pale or cyanotic (blue) in colour and cool to touch.

Treat any wounds.

Use an ‘elevation arm sling’.

Position the affected arm with the casualty’s hand placed on the opposite shoulder.

Using the longest side of the sling, drape it on top of the arm.

Gently tuck the sling under the arm up to elbow forming a pocket for the injured arm.

Gather the rest of the sling at the elbow and twist anti-clockwise.

Pull the sling around the back of the casualty firmly and tie off on the uninjured side.

Pad under the knot.

Continue to check the limb for circulation.

If required, you can place a broad fold bandage around the casualty to secure the arm to the casualty’s chest. This is to prevent movement of the arm. If the casualty has found a comfortable position with the fractured collarbone try and splint it in this position.

DO NOT let the casualty eat or drink anything until seen by a doctor, in case surgery is required.

Reassure the casualty.

Monitor the casualty for signs of shock.

 

Fractured Upper Arm (Humerus)

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance.

Check for warmth or pulse to the hand on the injured side; if no circulation gently adjust the position of the limb until circulation returns. This should only be done with great care and if the arm is showing signs of insufficient circulation i.e. skin is pale or cyanotic (blue) in colour and cool to touch.

Treat any wounds.

Use a ‘collar and cuff sling’.

Lay a narrow bandage down; make two loops with the bandage, with one end coming out on opposite sides of the middle.

 

 

Fold loops together, place the casualty’s hand through the loops and gently tighten.

Raise the hand to the uninjured side, near the shoulder.

Tie off the ends around the casualty’s neck.

Pad under the knot.

Continue to check the limb for circulation.

DO NOT let the casualty eat or drink anything until seen by a doctor, in case surgery is required.

Reassure the casualty.

Monitor the casualty for signs of shock.

If the casualty has found a comfortable position with the fractured arm, try and splint it in this position.

Fracture of Lower Arm (Radius or Ulna) and Wrist (Carpals)

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance.

Check for warmth or pulse to the hand on the injured side; if no circulation gently adjust the position of the limb until circulation returns. This should only be done with great care and if the arm is showing signs of insufficient circulation i.e. skin is pale or cyanotic (blue) in colour, skin is cool to touch.

Treat any wounds.

Use a ‘arm sling’.

Place a splint under the lower arm e.g. board or folded newspaper.

Tie the splint with narrow fold bandages above and below the fractured bone.

Hand should be held at waist height.

Place triangle bandage under injured arm with the point of the bandage towards the elbow.

The long side of the bandage should be running down the uninjured side of the body.

Bring the bottom end of the triangular bandage up and over the fractured arm, then place over the shoulder on the injured side.

Tie both ends together, tying the knot on the uninjured side.

Twist the end at the elbow until firm and then tuck in.

Continue to check the limb for circulation.

DO NOT let the casualty eat or drink anything until seen by a doctor, in case surgery is required.

Reassure the casualty.

Monitor the casualty for signs of shock.

 

Fractures of the Leg (Femur, Tibia, Fibula)

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance.

Check for warmth or pulse to the foot on the injured side; if no circulation gently adjust the position of the limb until circulation returns. This should only be done with great care and if the leg is showing signs of insufficient circulation i.e. skin is pale or cyanotic (blue) in colour and cool to touch.

Treat any wounds, stop any external bleeding.

Immobilise the limb i.e. prevent movement and use of the limb.

Place splint between the legs – if not available, pad between the legs and use the good leg as the splint.

Continue to check the limb for circulation.

DO NOT let the casualty eat or drink anything until seen by a doctor, in case surgery is required.

Reassure the casualty.

Monitor the casualty for signs of shock.

Circulation must be checked after a splint or sling has been applied. If the limb swells this will make the bandages tighter and this may cause circulation problems.

Indications that a bandage may be too tight include:

  • Absent pulse below the bandage.
  • Pale/blue appearance below the bandage.
  • Lack of warmth below the bandage.
  • Pain.
  • Swelling.
  • Tingling or loss of feeling in fingers or toes.

Following a Fracture:

Always refer the casualty to a medical professional for further examination and diagnosis of fractures.
Bone fractures are diagnosed with x-rays, CT and MRI scans.
Broken bones heal by themselves – the aim of medical treatment is to make sure the two pieces are lined up correctly.

Subsequent x-rays are taken to monitor the bone’s healing progress.

 

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