First Aid for Bone Injuries

There are, broadly speaking, two types of bone injuries that concern a first-aider. The one is a fracture, the other a dislocation.

When a bone injury occurs, it is not just the bone that is affected; the surrounding tissue and their functions are also affected.

FRACTURES

A fracture is a break or crack in a bone. Adult bones require considerable force to break, but children's bones are more flexible and supple. These young bones sometimes split instead of breaking. This is called a greenstick fracture.

The elderly's bones aren't as resilient as they used to be and are prone to breaking more easily. The elderly usually break the head of the femur (the upper leg bone) where it connects with the hip.

A fracture where the bone protrudes through the skin is called an open fracture. A fracture without a surface wound is a closed fracture.

Fractures are caused by either direct or indirect force. Direct force is a blow that affects the bone under its impact, causing it to break. Indirect force is when the impact caused a fracture at a distant point, e.g. a twisting action in the ankle breaks a bone in the lower leg or, by falling on outstretched arms you break the collar bone.

Priorities:

If the casualty is unconscious, ensure that the casualty's airway is open, that the casualty is breathing and that there is a carotid pulse.
Control bleeding, but do not apply direct pressure. Press firmly next to the fracture, this is called indirect pressure. Never touch the bone, because this could lead to severe infection.
Immobilize the fracture.

You will notice:

Discomfort around the fracture.

You may notice:

Swelling and bruising.
Pain.
Shortening of the affected limb.
Unusual shape to the affected area.
A grating sound if the bone ends move.
Difficulty and discomfort in movement.
With fractures of the small bones in the hands and feet, there may be normal movement accompanied by severe discomfort, but little visible signs of injury.

Note:

With fractures of bones that protect the body's organs (skull, ribs, pelvis etc.) always suspect underlying organ injuries.

DISLOCATIONS

Following a strong wrenching force or a violent contraction of muscles, it is possible for a bone to become displaced at a joint. It most commonly happens at the shoulder, finger, thumb and jaw.

You will notice:

Swelling.
Discomfort.

You may notice:

Pain.
An unusual shape to the affected joint.
Bruising. Treatment:
Do not try to force the dislocated part back in its socket.
Put a cold compress on the affected area.
Seek medical attention.

OPEN FRACTURES

An open fracture is when there is a wound over the broken bone. The bone may, or may not, be protruding from the wound.

Treatment:

Control bleeding by using indirect pressure.
Cover the wound with something non-fluffy and clean.
Immobilize the fracture.
Summon medical help.

If the bone is protruding from the wound:

Build up pads of non-fluffy material around the protruding bone.
Cover the area with a sterile dressing.
Do not attempt to push the bone back into the wound and do not touch the bone.
Check for circulation on the finger or toe below the fracture by pinching a nail. If color does not return to the nail within 5 seconds there is no or poor circulation to the limb.
Immobilize the affected part.
Provide support to the area.
Get medical help.

SKULL FRACTURES

You will notice:

A wound or bruise on the head or around the eyes.
A soft area on the scalp.
A depression (dent) on the scalp.
A thin, watery discharge from the ear and nose.
An unusual shape to part of the head.

Treatment:

If the casualty is unconscious, check that the airway is open, that the casualty is breathing and that there is a carotid pulse. Act accordingly.
If the casualty is conscious, lay him down with head and shoulders raised and supported.
Phone emergency services

FRACTURED PELVIS

Always suspect a fractured pelvis if the casualty has been crushed across the upper legs or lower abdomen or if the casualty has a fractured femur (upper leg) as a result of a car accident.

You will notice:

Pain.
An urge, but inability to pass urine.
Shock.

Treatment:

Lie the casualty down on his back, only if you can safely move the casualty. If you suspect a spine or neck injury, do not move the casualty.
Treat the casualty for shock, however, do not raise the legs.
Tie a belt or something similar around the casualty's hips. You do this because very important arteries move through the pelvis and moving bones can sever these arteries resulting in a fatality.
Dial emergency services.

FRACTURED ELBOW

A fracture around the site of the elbow is relatively common, and extremely painful. Children particularly are prone to fracturing the humerus (upper arm bone) just above the elbow. This type of fracture is unstable and can cause damage to the surrounding blood vessels and nerves. It is very important that the first-aider check for a pulse in the wrist frequently. Another common fracture around the elbow is to the head of the radius (lower arm bone closest to the thumb).

You will notice:

Pain.
Discomfort.
Swelling.
Possible bruising.
An unusual shape to the elbow area.
A grating sound when the bones move.
Difficulty in moving.
In the case of the radius being fractured, the elbow will be unusually stiff.

Treatment:

Put the arm in a sling or splint the arm in the position that was adopted by the casualty. Do not try to straighten the arm or force it into a particular position.
Splinting: Place a towel underneath the arm and one between the arm and the body. Use a bandage (or something similar) and tie it around the arm below the fracture. Tie another bandage above the fracture. Put the arm in a sling. If you do not have a sling or a triangular bandage, use a towel or a T-shirt. Ensure that the casualty does not under any circumstances move the arm.
The brachial artery runs through the upper arm and can be cut off by a fractured humerus; for this reason it is very important to check for a wrist pulse every 10 minutes. Also, check circulation by pinching a nail on the hand of the affected arm.
Phone emergency services.