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A fracture is a broken or cracked bone. The break is usuallly complete, but in the yong the bone can be bent without breaking completely. This is called a greenstick fracture. Correct first aid management of fractures, in both conscious and unconscious casuaties, is essential, in order to reduce the amount of tissues damage, bleeding, pain and shock.

CONTENTS

Causes

Effect

Type

Symptoms and Signs

Management

Fracture Collar bone

Fracture Upper Arm

Fracture Forearm

Fracture Of The Hands And The Fingers

Fracture Thigh

Fracture Wrists

Fracture Neck Of The Thigh Bone

Fracture Kneecap

Fracture Lower Leg

Fracture Feet And Toes

Fracture Ankle

 

 

 

Causes

  • direct force - a blow that breaks the bone at the point of impact
  • indirect force - when the bone breaks at some distance from the point of impact,e.g. where a fall on an outstretched hand results in a fracture of the collarbone
  • abnormal muscular contraction - a sudden contraction of a muscle may result in a fracture,e.g. an elderly person snapping the keecap after tripping and trying to prevent a fall.
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Effect

  • bleeding - fractures of large bones may result in considerable loss of blood,e.g. a fractured thigh results in the loss of 1 or 2 litres
  • damage to surrounding tissues and blood vessels
  • pain
  • possibly shock.
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Type

  • closed - skin is unbroken and blood is lost into tissues
  • open - a wound leads to be fracture, or bone protrudes through the skin. Blood loss may be severe, and infecion can result
  • complicated - vital organs may be damaged, e.g. rib fracture with an injury to the lung.
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Symptoms and Signs

  • the break may have been felt or heard
  • pain at or near the site of the injury
  • difficult or impossible normal movement of the limb
  • loss of power
  • deformity, abnormal twist or shortening of limb
  • tenderness when gentle pressure is applied
  • swelling over the fracture, and possibly around it
  • bruising
  • a coarse grating sound if one end of the bone moves against the other. Never actively seek this sign as further injury nay result.
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Fracture Collar bone

  1. DRABC
  2. control bleeding and cover all wounds
  3. check fo=r fractures - open, closed or complicated
  4. ask the casualty not to move the injured part
  5. immobilize fractures with slings, bandages or splints to prevent movement at the joints above and below the fracture
  6. watch for signs of loss of circulation to the foot or hand
  7. move the casualty only if there is danger to you or the casualty
  8. handle gently
  9. observe casualty carefully and manage shock if necessary
  10. seek medical aid.
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Fracture Upper Arm

Sympton and signs

  • pain, made worse by movement of the shoulder
  • history of a fall onto the outstretched arm or elbow
  • the casualty may support the arm at the elbow and incline the head towards the injured side
  • the shoulder appears to be lower than the uninjured side
  • tenderness and swelling around the collarbone

Management

  1. DRABC
  2. follow the general rules for fracture management
  3. support the arm on the injured side .
  4. seek medical aid.
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Fractured upper arm

Symptons and signs

  • pain
  • loss of function
  • swelling
  • the casualty may support the injured arm below the fracture.

Management

  1. DRABC
  2. follow the general rules for fracture management

If the injury is closed to, or involves the elbow:

  1. lay the casualty down, supporting the injured area
  2. check the pulse at the wrist and the colour of the hand and finger
  3. gently place the injured limb on supporting material by the side of the body. Do not bend the elbow
  4. immobilize the arm firmly to the body with broad bandages
  5. tie bandages in front on the uninjured side
  6. check the pulse
  7. seek medical aid.

If the injury is not close to the elbow:

  1. apply a collar and cuff sling
  2. do not support under the elbow. Allow the elbow to hang freely
  3. place soft padding between the elbow area and the chest
  4. immobilize the arm with two broad bandages (or narrow ones for a small person): - one above the fracture, over the arm and surround the chest . - the other below the fracture
  5. tie off the bandages in front on the uninjured side
  6. check the pulse
  7. seek medical aid.
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Fracture Forearm

Symptoms and signs

  • pain
  • loss of power
  • deformity
  • the casualty may support the injured forearm with the other arm.

Management

  1. DRABC
  2. follow the general rules for fracture management.

If fracture is not near the elbow:

1. immobilize the limb firmly to a splint which extents from the elbow to the finger. Bandage:

- above the fracture, below the elbow

- below the fracture

- at the wrist / hand

2. apply an aem sling

3 . seek medical aid

4 . check pulse and colour of finger.

If the fracture is near the elbow :

  1. immobilize the arm in the position found
  2. check the pulse
  3. seek medical aid urgently.
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Fracture Of The Hands And The Fingers

Symptons and signs

  • pain
  • swelling
  • deformity
  • bleeding, if there is a wound.

Management

Hand Fractures

  1. DRABC
  2. place soft padding between the chest and the limb
  3. support at the arm with a broad bandage over the forearm, tied off on the uninjured side
  4. check pulse
  5. seek medical aid.

Finger or thumb fractures

  1. DRABC
  2. rest the injured hand on a well padded splint and secure with a bandage
  3. elevent the hand for as long as possible
  4. seek medical aid.
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Fracture Thigh

Symptons and signs

  • usually a history of a fall on an outstretched hand
  • pain and swelling
  • tenderness
  • weakness of the hands and fingers
  • deformity often present.

Management

  1. children may prefer to support their own wrist. Allow them to do so
  2. rest the forearm and hand on a well padded splint. Additional padding under the hand and wrist may be required
  3. secure the limb to the splint by bandaging below the elbow, across the back of the hand and around the middle of the forearm
  4. elevate the limb
  5. apply a large arm sling
  6. seek medical aid.
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Fracture Neck Of The Thigh Bone

Symptoms and signs

  • severe pain at the site of the injury
  • loss of power
  • tenderness at the site of the injury
  • deformity
  • swelling
  • possibly a rotation of the foot of the injured leg
  • possible shortening of the injured leg
  • shock.

Management

  1. DRABC
  2. cover open wounds
  3. place padding between legs
  4. gently bring uninjured limb to the injured limb
  5. apply a figure-of-eight bandage around the knees and tie on the uninjured side
  6. seek medical aid.

If expert assistance is likely to be delayed:

1 . DRABC

2 . cover open wounds

3 . gently bring uninjred limb to the normal position

4 . place a well padded splint between the legs

5 . place one hand under the heel and the other around the toes of the injured limb

6 . gently draw down to apply traction to the foot, while rotating the leg to a position as nearly normal as possible against the splint

7 . apply a narrow figure-of-eight bandage around the ankles and feet

8 . pass bandages under:

- the thighs above the fracture

- the thighs below the fracture

- both knees

- between the kneew and the ankles

9 . tie on the uninjured side

10 . check the circulation of both limbs ( note the colour and temperature of the skin and feet ).

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Fracture Wrists

Symptoms and signs

  • pain in the area of the hip, thigh or knee when moving the limb
  • loss of power
  • tenderness over the hip
  • putward rotation of the foot of the injured leg
  • shortening of the injured leg
  • bruising ( seen later ).

Management

  1. DRABC
  2. if the casualty has been lying on the ground for a long period of time, manage any scalds to the skin from urine and faeces
  3. reassure the casualty comfortable
  4. place padding between legs and under tender spots
  5. apply a igure-of-eight bandage at the ankle and a broad bandage at the knees
  6. seek medical aid.
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Fracture Kneecap

Symptoms and signs

  • pain over kneecap, aggravated by movement
  • loss of power at the knee
  • inability to straighten the leg
  • tenderness and swelling over the kneecap
  • sometimes a gap can be felt at the front of the knee
  • sometimes the displaced kneecap can be felt.

Management

1 . DRABC

2 . lay the casualty on the back with head and shoulders raised

3 . raise the leg about 30 centimentres and support it in the most comfortable position

4 . do not attempt to straighten the knee

5 . if the limb can be splinted without increasing discomfort, then

- apply a pressure bandage around the knee ( figure-of-eight crepe or conforming bandage )

- apply a splint along the back of the limb from buttock to beyond the heel

- ensure that the splint is adequately padded, particularly under the natural hollows of the knee and ankle

- secure the limb to the splint by a figure-of-eight bandage around the thigh, and broad bandage around the lower leg

- seek medical aid.

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Fracture Lower Leg

Symptons and signs

  • pain
  • inability to walf
  • shortening of injured leg
  • deformity
  • swelling
  • rotation of foot of injured leg
  • protruding bone
  • bleeding

Management

  1. DRABC
  2. control bleeding and cover wounds
  3. place padding between the legs
  4. bring the uninjred limb to the injured limb
  5. steady and support the injured limb
  6. apply a figure-of-eight bandage around the ankle and feet
  7. apply a broad bandage the knees, and tie on the uninjured side.

If expert assistance is delayed :

  1. DRABC
  2. control bleeding and cover wounds
  3. lace a well padded splint between the legs, from the thighs to the ankles
  4. pad between the thighs, knees and ankles
  5. apply a figure-of-eight bandage aound the ankles and feet
  6. apply a broad bandage around the thighs, at the knees, above and below the fracture
  7. seek medical aid.
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Fracture Feet And Toes

Symptoms and signs

  • pain
  • inability to walk
  • tenderness
  • swelling

Management

  1. DRABC
  2. only remove shoes and socks if there is an open wound
  3. if casualty is not wearing shoes, apply a compression bandage
  4. raise foot and rest on pillow
  5. seek medical aid.
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Fracture Ankle

This fracture may be mistaken for a sprain, particularly if no deformity is present.

Symptoms and signs

  • history of a twisting injury
  • pain and swelling on either or both sides of the ankle
  • inability to bear weight on the ankle
  • tenderness, particualrly over the bony prominences on either side of the ankle
  • deformity, which may be severe.

Management

If no deformity is present :

  1. RICE
  2. avoid any weight bearing on the affected limb
  3. seek medical aid.

If deformity is present :

  1. steady and support the injred limb on pillows or a folded blanket
  2. do not apply any compression bandages around the ankle
  3. seek medical aid urgently.
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[Introduction] [What a first aider uses?] [DRABC] [Shock] [Bleeding] [Burns] [Limb injuries] [Fractures]

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