Lecture 4

Broken bones and fractures

• Definition: A break or crack in a bone is called a
fracture.
• In most cases the damage to the bone will be
under the skin, which is called a closed fracture,
• But sometimes bits of the bone can puncture through
the skin to become an open fracture.
• In both cases you'll need to treat the casualty for
shock.
• Even if you can't see any blood, the break might
have caused some internal bleeding.
• To break a fully grown bone, a huge amount of
force is needed
• But bones that are still growing are supple and can
split, crack or bend quite easily, a bit like a twig.
 Fracture
Signs:
• The seven things to look for are:
• Swelling
• Difficulty moving
• Movement in an unnatural direction
• A limb that looks shorter, twisted or
bent
• A grating noise or feeling
• Loss of strength
• Shock
 Types of fracture:
• Green stick fractures: Closed fracture mostly it occurs in
children..
• Complicated fractures: They occur when the jagged ends
of the bone fragments damage blood vessels, nerves or a
joint, broken bones in the chest may penetrate the lung,
heart or liver. In fractures of the skull the brain is usually
damaged.
• Depressed fractures: These occur in the skull when the
broken ends of the bones are pressed inwards.
• Commutated Fractures: In these cases, the bone is broken
into several fragments. This is serious because there will be
muscle damage with more bleeding at the fracture site.
 Types of fracture:
• Impacted Fractures: After a heavy fall, the fracture
may be impacted by the force, (eg.) Spinal injury
falling from tree.
• Pathological Fractures: These occur when the bone is
weakened by loss of calcium, infection or cancer.
Minimal cause a break in such cases. In old age the
bones are more brittle, and may break spontaneously
due to calcium loss which is part of the ageing process.
• Stress Fractures: Stress caused by repeated minor
trauma as in athletic training. Involved in strenuous
training, such as jogging or marathon running.
 Management:
• If it is an open fracture, cover the wound with a sterile dressing and
secure it with a bandage. Apply pressure around the wound to
control any bleeding.
• Support the injured body part to stop it from moving. This should
ease any pain and prevent any further damage.
• Once you’ve done this, call medical help. While waiting for help to
arrive, don’t move them unless they’re in immediate danger.
• Protect the injured area by using bandages to secure it to an
uninjured part of the body to stop it from moving. For example,
fractures on the arm can be secured with a sling, and a leg with a
fracture can be tied to the uninjured leg.
• Keep checking the casualty for signs of shock. This does not mean
emotional shock, but is a life-threatening condition, often caused by
losing blood.
• If they lose responsiveness at any point, open their airway, check
their breathing and prepare to treat someone who’s become
unresponsive.
•
 Splints:
• The main purpose of a splint is to keep an injured body part
immobilized (e.g. a broken leg).
• It should only be done if paramedics are going to take a long time
arriving, or if you have to move the person.
• Never move or try to realign the injured body part. Always splint
in the position found.
There are three main types of splints:
• 1. Anatomical: this means using a non-injured body part to
immobilize an injured body part. E.g. to splint a broken left lower
leg you would tie both legs together so the good leg provides
support to the injured leg.
• 2. Soft: this means using something like a thick sweat shirt, a
jacket, a towel, or a blanket to wrap around and immobilize.
This kind of splint works very well with hand or ankle/foot
injuries.
• 3. Rigid: this refers to using a firm object, such as a piece of wood,
to immobilize. There are many types of rigid splints you can
purchase or you can use whatever you see around you e.g.
magazines, newspapers, umbrellas, etc.
Injuries to the soft tissues:
• Definition:
– This is an injury to a bone, a joint, a ligament,
or a tendon.
– Joint injuries usually involve a dislocation.
– This is where the bone has popped out of its
socket.
– This may be accompanied with a fracture, a
strain, or a sprain.
– It may pop back in it may not.
– Either way seek medical help.
– Do not push it back into place.
– Tendons are strong tissues that connect a muscle
onto a bone.
– When a tendon tears it is called a strain.
– When they become torn they take a very long
time to heal, many times never as good as
before, and sometimes surgery is required to
reattach them.
– When a ligament is torn it is called a sprain.
– Ligaments connect a bone to another bone.
– These are found around the joints.
– Ligaments are very strong, but, as with tendons,
when they tear they take a long time to heal,
never as good as before, and sometimes
surgery is required.
• Causes:
– Any kind of force that is greater than what
the tissue can withhold will cause such an
injury. Some common activities include
falling, twisting, getting hit, etc.
• Prevention:
– Use safety equipment and wear it properly.
– Use seat belts and car seats.
– Keep joints and bones strong through
weight bearing physical activities.
Signs/Symptoms:
• A ‘snapping’
noise.
• Pain.
• Deformity.
• Inability to move.
• Swelling.
• Bruising.
 Management:
– Apply the RICE principle.
• Rest the injured body part and the entire casualty.
• Immobilize the injured body part.
• Cold compress over the injury to reduce swelling.
• Elevate the injured body part if it can be done without
causing
further injury.
– Seek medical help.
– Do not rub or move the injured body part.
– If there is a protruding bone then bleeding will need to
be
taken care of by applying indirect pressure.
– Never straighten or realign an injured body part.
• Notes: Bone fractures, if set properly, will heal fully in a
few weeks and will be stronger than before. This
happens because the area builds up with more
calcification than before.