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  » First Aid  »  Fractures
First aid for broken bones generally involves protecting the bone and the rest of the body from further damage. Broken bones always necessitate treatment by a doctor.

GENERAL FRACTURE SYMPTOMS
  • Bone can be heard or felt breaking
  • Inability to move the injured part
  • Pain, tenderness to the touch
  • Swelling, discoloration
  • Deformity or misalignment
  • Bone pokes through the skin (compound fracture)
  • Internal bleeding (particularly in the case of broken ribs or pelvis)
GENERAL TREATMENT OF FRACTURES
  • Check the ABC's (airway, breathing, circulation). Survey the victim for other injuries and observe closely for signs of shock. Treat accordingly.
  • No attempt should be made to reset or straighten a broken bone; it should be splinted where it lies, with a minimum of movement.
  • If the bone has pierced the skin, bleeding should be controlled by direct pressure. Place a sterile dressing over the wound, splint the extremity, and take the victim to an emergency room.
  • Call an ambulance. Transport the victim yourself only if an ambulance is not available. First aid for specific types of fractures is described below.

HEAD INJURIES

Head injuries range from bumps and scrapes to scalp lacerations, skull fractures, concussions, and other brain injuries. They may involve a combination of individual injuries. Minor head injuries such as bumps or abrasions, without any signs of possible brain damage (listed below), can usually be treated by simple first-aid measures. You should always suspect a neck injury in the presence of severe facial or head trauma and follow the directions for treating a head or neck injury. Anyone who has received a blow to the head and has had a loss of consciousness should be brought to a hospital emergency room.

SYMPTOMS OF MILD HEAD INJURY

The person is conscious and shows no sign of brain or neck injury or fracture (see below) but is bleeding from the scalp.

TREATMENT
  • Check pulse and respiration. If the person is lying down, do not move or place a pillow or other object under the head.
  • Check for signs of brain or neck injury and treat accordingly.
  • Control bleeding by placing clean gauze over the injury. (Direct pressure may be applied.) Scalp lacerations can bleed profusely because of the large number of blood vessels in this part of the body, but bleeding can usually be easily controlled with pressure.
  • Take the person to a doctor.
SYMPTOMS OF SERIOUS HEAD INJURY
  • Large hematoma or depression of the scalp
  • Change in mental status such as agitation, confusion, lethargy, or loss of consciousness
  • Headache or vomiting
  • Amnesia about events before or after the head injury
  • Colorless or blood-streaked discharge from the nose or ears
  • Speech disturbances
  • Convulsions or paralysis
  • Eye pupils different in size from each other
TREATMENT
  • Administer CPR if breathing stops or if there is no heartbeat. Assume presence of neck injury, use the chin lift or jaw thrust without head tilt to open the airway and for rescue breathing.
  • Observe precautions for neck or spine injury. EXTREMELY IMPORTANT: Keep the head and neck in alignment with the rest of the spine in cases of suspected spinal injury.
  • Watch for signs of shock. Shock generally indicates that there are other injuries and may be the result of spinal injury or internal bleeding.
  • Keep the person lying as quietly as possible. Do not move unless absolutely necessary.
  • Do not attempt to give any fluids.

NECK OR SPINE FRACTURE

A neck or back injury should always be suspected after any accident or fall in which abnormal forces affect the back (e.g., automobile accident, whiplash, fall from a height where the person lands directly on the feet or back, any accident resulting in serious head and facial trauma).

SYMPTOMS OF A NECK OR SPINE FRACTURE
  • Neck or back pain
  • Odd position of the head or neck
  • Feelings of numbness, weakness, or paralysis in an arm, hand, leg or other part of the body
TREATMENT
  • Check for vital signs and perform CPR if necessary.
  • Keep the person absolutely still. Reassure the person if she is conscious, but do not allow her to move the head or neck. Immobilize the individual's head and neck in the position in which she lies. Support the back of the neck by carefully sliding a rolled pad underneath and by placing pads, pocketbooks, or other stabilizing items at the sides of the head.
  • If the person must be moved because of immediate, life-threatening danger (for example, fire, explosion, or noxious fumes), head and spine movement must be prevented. Immobilize head and spine by rolling her onto a firm object such as a stretcher, board, or door. If these are not available, a blanket may be used under the victim and dragged along the ground. At all times head and spine movement must be prevented.
  • Have several people carefully move the person, making sure the head and neck are held in a direct straight line ("neutral position") with the spine, without any forward or backward bending or sideways turning of the head. If you are alone and must act quickly, pull the victim to safety, preferably by the shoulders, using the forearms to maintain the head in a neutral position.
  • Summon emergency personnel to transport the victim to the hospital.

HIP OR PELVIS FRACTURE

These fractures are particularly common in the elderly, and may result from even a minor fall. In people with severe osteoporosis (thinning of the bones) the fracture may occur during normal activity and cause the fall. A person with a suspected fracture of the pelvis should not move, since this can damage pelvic organs.

SYMPTOMS

Pain in the hip, groin, lower back, or pubic area, especially with movement of the leg. With a hip fracture the leg may be shortened and the foot turned outward.

TREATMENT
  • Do not move the person unless absolutely necessary.
  • If movement is necessary, follow the same procedure as outlined for a spinal injury. Do not permit any movement of the torso and legs. Tie the legs together at the ankles and knees and transport the person on a firm surface (backboard). The leg may appear to be shortened and rotated out. Do not attempt to straighten it.
  • Look for signs of shock and treat appropriately.
  • Call for emergency medical help and an ambulance.

LIMB FRACTURE

Injuries to the wrist and ankle should be treated the same as the arm or leg until they are x-rayed to determine the extent and nature of the injury.

SYMPTOMS
  • Patient describes hearing or feeling the bone break.
  • Pain, swelling or discoloration.
  • Inability to move, put weight, or use the injured part.
  • Deformity or misalignment.
  • Grating sound or feeling when the bone moves.
TREATMENT
  • If the skin is broken at any point along the arm or leg, stop the bleeding by applying direct pressure. Take care, however, not to move the bone. Cover open fractures with a sterile dressing.
  • Do not permit the person to use or "test" the injured part.
  • If the person is lying down as the result of a fall, do not move, but keep as comfortable as possible by putting a pillow under the head and covering with a blanket.
  • Immobilize the injured limb by splinting it in the position in which it is found. Almost any object that is rigid and the correct length can serve as a splint: boards, broom handle, cane, branch, or tightly rolled newspapers.
To make a splint:
  1. Make the splint longer than the bone it will support.
  2. Pad the splint with soft material such as a sheet, cloth, or clothing before placing it against the fractured bone.
  3. Tie the splint to the injured limb snugly but not so tightly that it constricts circulation. Leave the tops of the fingers or toes out and check regularly to make sure circulation is not impeded.
  4. Support a fracture of the arm with a sling to prevent further injury and provide pain relief.
OTHER BROKEN BONES

Almost any bone can be broken, including the cheek, nose and other facial bones, the ribs, and small bones of the hands or feet. These bones usually do not have to be splinted. If there is bleeding, it should be controlled. Take care in transporting the person to an emergency room or a doctor who can make the appropriate x-ray studies and initiate treatment. While it may take up to 6 months or even a year for a broken bone to fully heal in an adult (children heal more quickly), it is not necessary to wear a cast for that long. However, care should be taken to avoid undue stress on the bone until complete healing has occurred.