FRACTURES FIRST AID AND EMERGENCY CARE LECTURE 9

DEFINITION A fracture is any break in a bone, including chips, cracks, splintering, and complete breaks

CAUSES OF FRACTURES 1. Direct Force: The bone breaks at the spot of application of the force such as in direct hit over a bone, bullet injury 2. Indirect Force: The bone breaks away from the application of force somewhere else such as after falling on outside stretched hands. 3. Force of powerful muscle actions: such as violent cough may cause rib fracture

4. Aging: and bone disease which can increase the risk of fractures (pathologic fractures), with bones breaking even with minor accidents 5. Twisting forces: such injuries are often seen in football and skiing accidents where a person's foot is caught and twisted with enough forces to fracture a leg bone.

Types of fractures

TYPES OF FRACTURES A.Basic Types of Fractures 1. Closed Fracture (Simple fracture): Occurs when a bone is broken but there is no penetration extending from the fracture through the skin.

2. Open Fracture: (Compound fracture): Is a fracture in which there is a wound over the fracture site, with or without bone protruding through it. This type of fracture is more serious than closed fractures because the risks of contamination and infection are greater

Types according to appearance on x-ray 1. Green stick fracture: Usually occurs in children whose bones are still pliable (like green sticks) A break occurs straight across part of the width of the bone, perpendicular to the long axis 2. Transverse Fracture: Cuts across the bone at right angles to its long axis, often caused by direct injury

3. Oblique Fracture : The fracture line crosses the bone at an oblique angle 4. Comminuted Fracture: The bone is fragmented into more than two pieces 5. Impacted Fracture: The broken ends of the bones are jammed together 6. Spiral Fracture: Usually results from twisting injuries The fracture line has the appearance of a spring

SIGNS AND SYMPTOMS OF FRACTURES 1. Pain Pain is the primary symptom of fractures Pain is often severe and constant and is felt at or near the site of fracture snap 2. Swelling and discoloration These begin shortly after injury Discoloration my start as reddening of the skin 3. Tenderness or Discomfort It leads to severe restriction or use of the area affected

4. Inability to move a joint 5. Numbness / tingling sensation 6. Loss of distal pulse 7. Slow capillary refill 8. Bone breaking through the skin 9. Deformity.

Emergency care steps for patient with musculoskeletal injuries 1. Primary assessment: Assess and provide support for the ABCs. Manage life-threatening conditions first. Prioritize and manage other injuries second 2. Carefully cut away the clothing to expose the injury site. Control bleeding (open wound). Check for distal circulation, sensation and motor function in the affected extremity.

Emergency care steps for patient with musculoskeletal injuries 3. Immobilize the extremity using manual stabilization or splints, if available. 4. Apply cold pack to injury site to help reduce the pain and swelling. 5. Administer oxygen 6. Assess the patient’s vital signs. Maintain body temperature to help minimize the effects of shock.

Algorithm for emergency care of patients with musculoskeletal injuries Painful swollen deformed extremity Expose injured site Immobilize the extremity Apply cold pack to control bleeding & reduce pain / swelling Maintain body temperature, administer oxygen

Splinting Splinting is the process of immobilizing an injury, using a device like piece of wood, cardboard or folded blanket.

Types of Splints 1. Soft splints : pillows, blankets, towels & dressings are effective in stabilizing injuries. 2. Commercially Available Splints: Rigid splints (padded board, aluminum splint) 3. Improvised splints: Rolled newspaper, Wood, Strong cartons, Cane, Ironing board, and any other objects that can provide stability 4. Inflatable splints or air splints 5. Traction splints

General Principles Of Splinting The clothing is best removed from the area of any suspected fracture or dislocation Note and record motion and sensation status distal to the site of injury The splint should immobilize the joints above and the joints below the fracture. During splint application, minimal movement of the limb should be allowed. Severely deformed limb should be straightened with constant gentle manual traction so that the limb can be incorporated in to the splint.

General Principles Of Splinting If gentle traction increases the patient's pain significantly or if resistance to the limb alignment is encountered, the limb must be splinted in the position of deformity. Cover all wounds with dry sterile dressing before applying a splint. Pad the splint to prevent local pressure. Do not move or transport patients before splinting extremely injuries.