First Aid - Fractures

Any break in the continuity of a bone is called a fracture. Fractures are usually caused by an injury; occasionally they are due to bone disease. They vary considerably in severity. 

Almost in the event of fracture, there is some damage to the surrounding tissues. The injury that caused the fracture may badly bruise the area near the fracture. Bone ends may cut vessels, tendons, nerves and blood vessels. the more injured part is moved, the more damage there will be. Cut blood and lymph vessels leak into area, causing swelling. Swelling will increase for the first 24 hrs then begin to diminish. The blood forms an ecchymosis (a "black and blue" spot). This goes through color changes as the blood pigments disintegrate. The color changes from black and blue, through green, to yellow. The pigments are finally reabsorbed into the body. Often, ecchymosis will be away from the fracture site, as gravity tends to pull the fluids downwards.

The muscles around the fracture go into spasm. Usually, this serves to "splint" the movement. Occasionally, this can actually displace the ends of the bone, that is pull them apart.

Most often, a fracture is easy to recognize. The broken part is twisted into an unnatural position, and the person can move part only with difficulty or not at all. Occasionally though, there may not be an observable deformity and movement may still be possible and easy.

Fractures may be classified as:

• Simple, where the broken ends of the bone do not cut open the skin
• Compound, where the broken end of the bone may have cut the skin. Either the injury that fractured the bone penetrated the skin, or the broken end of the bone cut through the tissue and protruded through the skin.
• Complicated, where in addition to the fracture an important internal organ may also be injured. A complicated fracture may also be simple or compound.

First Aid

• The first thing to do is to make sure that the person can breath. Clear the mouth of any mucus, vomitus, or blood. Make sure that the tongue does not fall back across the wind pipe. (See Artificial Respiration)
• Next, control bleeding: Apply direct pressure on an wound. Cover the open wounds with a clean, preferable sterile, dressing. Do not attempt to clean out the dirt or use an antiseptic.
• Immobilization of fractured part: This is necessary to prevent the sharp edges of the bone from moving and cutting tissue, muscle, blood vessels, and nerves. This reduces pain and helps prevent or control shock. In a closed fracture immobilization keeps bone fragments from causing an open wound and prevents contamination and possible infection. The basic splinting principle is to immobilize the joints above and below any fracture.
• Call all a doctor immediately or go to a emergency room immediately.

Warning: Unless there is immediate life-threatening danger, such as a fire or an explosion, DO NOT move the casualty with a suspected back or neck injury. Improper movement may cause permanent paralysis or death. In a chemical environment, DO NOT remove any protective clothing. Apply the dressing/splint over the clothing.

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.

• Splints, Padding, Bandages, Slings, and Swathes: 
  1. Splints: Splints may be improvised from such items as boards, poles, sticks, tree limbs, rolled magazines, rolled newspapers, or cardboard. 
  2. Padding: Padding may be improvised from such items as a jacket, blanket, etc or leafy vegetation.
  3. Bandages: Bandages may be improvised from belts or strips torn from clothing or blankets. Narrow materials such as wire or cord should not be used to secure a splint in place.
  4. Slings: A sling is a bandage (or improvised material such as a piece of cloth, a belt and so forth) suspended from the neck to support an upper extremity. Also, slings may be improvised by using the tail of a coat or shirt, and pieces torn from such items as clothing and blankets. The triangular bandage is ideal for this purpose. Remember that the casualty's hand should be higher than his elbow, and the sling should be applied so that the supporting pressure is on the uninjured side.
  5. Swathes: Swathes are any bands (pieces of cloth and so forth) that are used to further immobilize a splinted fracture. Triangular and cravat bandages are often used as or referred to as swathe bandages. The purpose of the swathe is to immobilize, therefore, the swathe bandage is placed above and/or below the fracture--not over it.

Procedures for Splinting Suspected Fractures

Ensure that splints are long enough to immobilize the joint above and below the suspected fracture. If possible, use at least four ties (two above and two below the fracture) to secure the splints. The ties should be nonslip knots and should be tied away from the body on the splint. Splint the fracture (s) in the position found. DO NOT attempt to reposition or straighten the injury. If it is an open fracture, stop the bleeding and protect the wound.

Figures below shows the proper way in which splinting should be done for various position and note that the knots are away from the body of splints:

Improvised splints for lower arms using a pillow when no board or similar rigid material is available.	Improvised splints for lower arms using newspapers when no board or similar rigid material is available.	Improvised splints for arm and hand using a board. The arm must be supported by a sling. A second board (one on either side of bone) can also be used.
A large hairpin makes a handy emergency splint for a broken finger. Tape it securely for the trip to the doctor.	If you suspect that someone's foot is fractured, Do Not Remove the Shoe. Place a board beneath the sole and tie it to the shoe. Do not permit the patient to walk on foot. Carry him or transport him on stretcher.	Left: Improvised splint for fracture of leg. A piece of board is wrapped in cloth for cushioning. One end of cloth may be brought around the foot. Four separate strips of cloth, fastened with square knots, hold the splint in place. Right: For this splint, a rod or stick is tied around the leg, which was given a protective wrapping of cloth.

How to make a Triangular and Cravat (Swathe) Bandages

Triangular and cravat (or swathe) bandages are fashioned from a triangular piece of muslin (37 by 37 by 52 inches) provided in the general purpose first aid kit. If it is folded into a strip, it is called a cravat. Two safety pins are packaged with each bandage. These bandages are valuable in an emergency since they are easily applied.

To improvise a triangular bandage, cut a square of available material, slightly larger than 3 feet by 3 feet, and FOLD it DIAGONALLY. If two bandages are needed, cut the material along the DIAGONAL FOLD. A cravat can be improvised from such common items as T-shirts, other shirts, bed linens, trouser legs, scarfs, or any other item made of pliable and durable material that can be folded, torn, or cut to the desired size.

Updated on: 01 Feb 2010