By definition fractured means ‘broken’. There are, however, almost as many different types of fractures as there are bones in the body.
In most cases a fracture will fall into one of two main groups: a ‘closed’ or ‘simple’ fracture where the bone is broken but the skin is not lacerated; and an ‘open’ or ‘compound’ fracture where the skin is pierced by the bone or by a blow that breaks the skin at the time of the fracture.
It is very difficult, and unnecessary, for the average first-aid provider to diagnose the exact type of fracture, and treatment for all types is basically the same. However, we’ll look at three of the most common types.
• A transverse fracture is a clean break at right angles to the long axis of the bone.
• A ‘greenstick’ fracture occurs when the bone is bent but doesn’t actually break and a series of small cracks appear. This type is common with small children as their bones are still quite flexible.
• A comminuted fracture results in the bone being shattered into three or more pieces.
Fractures can happen in a variety of ways, but there are three common causes. Trauma, such as a fall or a sudden impact accounts for most fractures.
Osteoporosis is a disease that causes thinning of the bones and is common with the elderly. The bones become fragile and easily broken.
Overuse of a particular part of the body can sometimes cause stress fractures. This type of fracture is common with athletes.
Usually a patient will immediately know if they have broken a bone. They may hear a snapping or cracking sound and the area will be extremely painful. Bruising and swelling is also common.
Stress fractures are a little more difficult to detect but there is usually pain, tenderness and swelling associated with this type.
As always, treatment begins with the ABCD’s. Since fractures are commonly associated with significant force, such as a motor vehicle accident, it is extremely important to assess the scene for potential hazards.
Remember to assure your own safety first. Activate EMS, don barriers (gloves) and begin your primary assessment by monitoring the patient’s ‘lifeline’.
Make sure the patient has an open airway, is breathing and has circulation, then treat for spinal injuries, shock, and any serious bleeding.
With compound fractures it is important to control serious bleeding before treating the actual fracture. Under no circumstances do we ever attempt to straighten or re-set a fracture.
Treat the patient in the position you found them and instruct them not to move. The only time this rule is broken is if there is a significant risk of injury to you or the patient.
In most cases the emergency responder will simply monitor the patient’s lifeline, re-assure them and wait for EMS to arrive.
If EMS is delayed or unavailable you may need to immobilize the fracture and transport the patient to medical care yourself.
Splinting is the most effective way to immobilize a fracture and often will make the patient much more comfortable.
Again, do not straighten the affected area, splint it in the position you found it. Commercial splints are available and ‘wire splints’ are compact enough to keep in a first aid kit, however, if you don’t have a splint use whatever is available. Rolled up magazines and tree branches are two examples of items that can be used for a makeshift splint.
Secure the splint with a triangle bandage or other material and keep movement of the affected area to a minimum.
This weekly column is only an introduction to emergency care skills and is designed to increase interest in First-Aid/CPR training. For information on courses please contact the Red Cross, a medical professional, or a local dive shop.