Broken Bones
As you know, bones are a hard and strong tissue that give our body a framework. Bones in healthy person can break if they fall, or due to a blow to their body. Tripping over and using your arm to protect your face is a classic way some people break a bone on a bushwalk (I think I would prefer a broken arm then a broken face).
It can be difficult to tell in some cases if the injury is a sprain/strain, a dislocation or a fracture. If in doubt manage as a fracture.
Types of fractures
The terms 'broken' and 'fractured' mean the same thing. One is not worse than the other. There are different types of fractures, but in first aid, it is helpful to be aware of four types. We do not need to diagnose the type to provide first aid, but it is helpful to understand the wide range to help understand the signs and symptoms.
* Greenstick: The bone bends and cracks but is still joined. Like bending a green stick from a tree. These are most common in children as their bones have not fully hardened.
* Simple: A clean break of the bone (all the way through), but has not done significant damage to surrounding tissue. The limb may be at an unusual angle.
* Open: The bone has broken, dislodged and torn through the skin.
* Comminuted: The bone has broken in more than one place, leaving pieces of bone ‘floating’.
Signs and symptoms
Some people can fracture bones without a trauma (such as older people with osteoporosis), but typically a fracture will be caused by a fall or blow to the body.
The person is likely guarding the injured area, and some of the follow are likely present;
- The injured person may have heard or felt the break occur.
- They may report feeling a grating sensation.
- Significant pain or tenderness.
- Swelling.
- Deformity of the limb or area (compare to the other side).
- Redness or perhaps bruising.
- Loss of strength or function.
Manage
Keep the injured person still
Encourage the injured person to stay in the most comfortable position. Avoid moving them unless you need to for safety reasons. Broken bones are sharp and movement can cause internal injuries.
Control bleeding
If there is significant bleeding from the fractured site, control the bleeding by applying pressure above and below the fracture (avoid pressure on the actual fracture as this will be painful and likely to cause further damage).
Immobilise the fracture
When managing a fracture the goal is to prevent any further movement of the broken bones. If the bones are on an unusual angle (or even pierced through the skin), do not attempt to move them, as this is likely to cause further tissue damage or bleeding. Always manage immediate life-threating issues first (such as breathing issues or bleeding).
Assuming the injured person is conscious they will find the most comfortable position quickly. Find ways to help support them to maintain a comfortable position.
Generally, when managing a fracture with a long bone (arm, leg, hand, foot) you want to:
* Splint (using a parallel part of the body, a curved trampoline or foam mat).
* Secure the splint near the joint above and below the fracture using bandages (or tape for fingers/toes).
* Avoid applying pressure to the actual fractured site. This will cause significant pain and perhaps damage tissue. Some pressure may be necessary to control any significant bleeding.
* Minimise movement of the joints above and below the fracture by using a sling, or securing part of the limb to the body. In some situations, this may be done using ‘sandbags’ such as packs if there are no mobile alternatives.
Even with good first aid, there will still be some movement - so minimise movement of the injured person to manage safety and to improve comfort.
If you have to move a person due to a dangerous location (e.g. if they have fallen in a creek, or there is a fire), support the fractured limb the best you can and move the shortest distance needed to get to safety.
Immobilise lower arm/wrist
It is likely the person is holding their arms flat across their stomach. You can fold up the lower part of their t-shirt to help them support their arm to get them to a safer place.
You can remove their pack by undoing the straps to minimise arm movement.
* Splint the lower arm and wrist (using a padded folded tarp or foam mat).
* Use a triangular bandage to for a sling, generally to keep the lower arm horizontal, and the hand/wrist flat.
Immobilise upper arm or shoulder
It is likely the person is holding their arm/elbow to the side of their body. Their elbow may be straight or bend.
You can remove their pack by undoing the straps to minimise arm movement.
* Using the side of the chest as a splint.
* Use a triangular bandage to support the arm in the most comfortable position as they have presented. Try to keep the fracture in gentle traction. If the person is pushing up on their elbow or holding onto their wrist, then the sling should to the same.
* Pad the gaps between the limb and body/sling.
Immobilise finger/toes
It is likely the person is holding their finger/toe together with a neighbour finger/toe. The neighbour will become the splint.
You can remove their pack by undoing the straps to minimise arm movement to save them letting go of the injured area.
* Use a small amount of padding (if required) between the broken finger/toe and its neighbour.
* Use tape to secure broken finger/toe to the neighbour (the splint). If more splinting is required, a small padded flat splint (such as an ice cream stick) can also be taped on.
Immobilise leg
It is likely the person is laying on the ground in significant pain. Further movement of the injured leg is likely to be very painful and can cause significant further injury (such as bleeding).
Initially support the injured leg against the ground (or whatever it is against). Remove their pack by undoing the straps to minimise movement, and use their pack for a rest for their upper body.
* If you can bring the uninjured leg to be beside the injured one, then apply padding between the legs and tie the angles together with a broad triangular bandage. Secure the two legs together with more bandages above and below the injury.
* If the injured leg is in an awkward position, see if the person feels comfortable moving their upper body to get into a more comfortable position. (Chances are they did this as they fell). Use ‘sandbags’ (packs, padded rocks) and pad the gaps to keep the leg from moving and to make is as comfortable as possible.
Immobilise rib
It is likely the person is holding their hand across their chest (similar to a broken upper arm).
You can remove their pack by undoing the straps to minimise movement.
* Sit them in the most comfortable position possible, likely half sitting up, leaning towards the injured side. Use their pack as a rest.
* Use their arm as a splint, and secure, similar to a fractured upper arm, use t-shirt as some padding.
Organise evacuation
Most fractures will warrant medical evacuation. Any open or comminuted fractures, or any that cause severe pain will require urgent evacuation. Fractures to the skull or ribs will also require urgent evacuation.
Simple fractures that are stable, where the person is happy to lay still and wait, will still require evacuation, but are generally less life-threatening.
Generally, even people with a greenstick fracture to the arm will warrant an evacuation because of the risks of much more significant damage that could happen from another fall.
Some people may want to walk out.
Assess the risks, resources and issues around the dignity of choice for the person.
Medium-term management
Once you have called for assistance, help may be hours away. Especially when the injured person is immobile, the following are important things to consider.
Shelter. Build a shelter over the injured person. Move them as little as possible.
Comfort. Work with the injured person to get padding under them, such as a sleeping mattress. Use packs or other objects to lean against.
Shock. Monitor/manage for shock & keep the injured person warm.
Circulation. Check the colour of the skin below the injury for signs of reduced circulation or loss of pulse. If circulation is significantly reduced, apply firm but gentle traction.
Pain medication. The injured person may want to take painkillers such as paracetamol.
Nill by mouth. Avoid eating or drinking. Small sips of sweat drinks may be helpful if they are thirsty.
DRSABCD