CAUSES OF FRACTURE

Fractures can arise from direct force, where the injury manifests at the point of impact, such as from a blow or accident. Conversely, indirect force results in a break some distance from the point of application, indicating a transmission of force, exemplified by a fall from a height. Powerful muscle contractions can also lead to fractures, particularly in the patella (kneecap). Repetitive stress or force over time can cause stress fractures. Furthermore, underlying bone disorders can predispose individuals to pathological fractures. These disorders include:

• • • Osteomyelitis
    • Bone tuberculosis
    • Cancer
    • Advanced age leading to bone weakening
    • Bone tumors

Classification by Fracture Location

TYPES OF FRACTURES

SIMPLE OR CLOSED FRACTURE:

In this type of fracture, the bone is broken, but the overlying skin remains intact. It’s crucial to manage simple fractures correctly, as improper handling can lead to complications.

COMPOUND OR OPEN FRACTURE:

Here, the fractured bone is associated with a break in the skin. Sometimes, a sharp fragment of the broken bone protrudes through the skin, creating the wound. Significant blood loss is a potential concern with open fractures.

COMPLICATED FRACTURES:

These fractures, whether open or closed, involve injury to adjacent internal structures. For example, rib fractures can injure the lungs.

COMMINUTED FRACTURES:

This fracture pattern is characterized by the bone being broken into multiple fragments.

IMPACTED FRACTURES:

In this case, the broken ends of the bone are driven into each other.

DEPRESSED FRACTURE:

The broken segments of the bone are displaced inwards.

GREENSTICK FRACTURE:

This type of fracture involves a cracking or bending of the bone, rather than a complete break. It is more prevalent in children due to the greater flexibility of their bones.

GENERAL SIGNS

• Pain and sensitivity to touch are present at the injury location.
• Difficulty or inability to move the affected area.
  Swelling and fluid accumulation (edema).
• Visible distortion or misalignment of the body part.
• Changes in skin coloration (discoloration).
• Impaired or complete loss of function in the injured area.
• Unnatural or excessive movement in the affected part.
• A grating or crackling sound (crepitus) may be felt or heard if the limb is gently moved.
• The individual may exhibit signs of shock.
• Increased warmth around the fracture site due to increased blood flow.

AIMS OF FIRST AID

1. To avert further harm to the fractured bone.
2. To alleviate or minimize pain.
3. To ensure the individual’s comfort while awaiting professional medical assistance.
4. To counter the development of shock.

RULES FOR TREATMENT OF FRACTURES

• Avoid moving the injured part unless there is an immediate danger.
• Immediately stabilize and support the injured area to prevent movement.
• Provide reassurance to the injured person and arrange for medical help.
• Control any bleeding present.
  Cover any open wounds with a sterile dressing.
• Avoid unnecessary removal of the individual’s clothing.
• Attempt to prevent or manage shock by handling the person gently, keeping them warm, and providing sips of sugary drinks if there’s no possibility of needing general anesthesia.

GENERAL MANAGEMENT OF A CASUALTY WHO HAS SUSTAINED A FRACTURE

• Prevent the broken bone fragments from rubbing together by immobilizing the area and keeping the pieces aligned.
• Reassure the injured person.
  Ensure a clear and open airway for breathing.
• Stop any bleeding that is occurring.
  Treat any signs of shock.
• Reduce pain.
  Immobilize the fracture using splints and a sling, if appropriate.
• Avoid unnecessary movement of the injured part.

FRACTURE HEALING

FACTORS THAT IMPEDE BONE HEALING

• Excessive movement at the fracture site.
• Poor alignment of the fracture fragments, inadequate reduction, or significant bone loss during the injury.
• Compromised blood flow due to damage to blood vessels or surrounding muscle injury.
• Excessive fluid buildup (edema) at the fracture site.
  Infection at the fracture site.
• Metabolic disorders or systemic diseases such as cancer, diabetes, or malnutrition, which hinder bone formation (osteogenesis).
• Damage to surrounding soft tissues, disrupting blood supply.
• The use of certain medications like steroids or anticoagulants.
• Steroids can lead to osteoporosis, and long-term use of heparin can have a similar effect.

COMPLICATION OF FRACTURES

General complications include blood loss, deep vein thrombosis, pulmonary embolism, and respiratory distress.
Early complications involve infection, septicemia (blood poisoning), and pressure sores from casts.
Late complications can include joint instability, osteoarthritis, improper bone alignment (malunion), delayed healing, and failure of the bone to heal (nonunion).

MANAGEMENT OF SPECIFIC FRACTURES

FRACTURE OF THE SKULL

These fractures can be associated with injuries to the spinal cord or the brain. Conditions like concussion can also occur.

Concussion

Concussion refers to the shaking of the brain, which can lead to a loss of consciousness. It can also result from compression or pressure on the brain. The injured person might experience bleeding from the nose or ears and may be unconscious.

SIGNS AND SYMPTOMS

• A history of head trauma or an accident.
• Bleeding from the scalp or skull.
• Unequal or dilated pupils.
• Partial loss of consciousness.
• Vomiting.
• Slow pulse rate.
• Possible paralysis of limbs.
• Disturbances in eye movements.
• Speech difficulties.

MANAGEMENT

• Anyone with a head injury requires close observation and prompt medical evaluation.
• If conscious, the person should be positioned lying on their back with their head turned to one side and shoulders slightly elevated.
• If there is discharge from the ear, the head should be turned to the side of the affected ear, but do not block the ear canal.
• Maintain a quiet environment for the injured person.
  Dress any open wounds.
• If unconscious, place the person in the recovery position, monitor breathing, pulse, level of responsiveness, and document these observations.

FRACTURE OF THE SPINE

The primary concern with this type of fracture is the potential for spinal cord injury.

1. Manage shock while arranging for transportation to a medical facility.
2. Secure the legs together.
3. Place padding between the knees and thighs to prevent direct contact.
4. Require four individuals to safely lift the person.
5. Avoid any bending or twisting of the spine.
   The preferred transportation position is lying flat (recumbent).
   Transport should be done using a stretcher with a firm surface.

FRACTURE OF THE RIBS

Broken ribs can be pushed inwards, leading to complications.

• The person will report localized pain.
• The pain intensifies with breathing or coughing.
• The fractured end might damage underlying tissue, potentially leading to blood-tinged sputum.
• If a rib has punctured the lung, breathing may be shallow.
• Signs of internal bleeding might be present.
• Air might leak into the pleural space (between the lung and chest wall) or into surrounding tissues, potentially causing lung collapse.
• If air enters the tissues, it is known as Emphysema.

IF THE PATIENT PRESENT WITH THIS;

• Position the person in a seated position.
• Limit chest movement by applying broad bandages around the chest, secured on the unaffected side.
• Support the arm on the injured side with a sling.
• Cover any open wounds immediately to prevent air entry.
• The person can be positioned leaning on the affected side.
• Use pillows for support.
  Transport the person to a hospital.

FRACTURE OF THE CLAVICLE

This commonly results from indirect pressure, such as falling on an outstretched arm.

TREATMENT

• Support the injured arm.
• Place padding in the armpit (axilla).
• Secure the arm to the chest using a broad bandage.
• Alternatively, support the arm with a sling.

FRACTURE OF THE UPPER ARM

• The humerus bone can fracture near the shoulder, along its shaft, or towards the elbow.
• Sometimes, the lower end of the radius bone in the forearm may be fractured.
• Fractures of the metacarpal bones in the hand can also occur and may be associated with bleeding into the palm.

MANAGEMENT

• The injured limb must be immobilized.
• If the elbow can bend comfortably without increasing pain, flex the arm across the chest, with the fingers pointing towards the opposite shoulder.
• Place padding between the arm and chest and secure it with a collar and cuff sling.
• Bind the arm firmly to the chest.
  If the elbow cannot be bent without causing pain,
• secure the limb to the torso with broad bandages.
  Alternatively, splints can be used for immobilization.
• Transport the person in the position of greatest comfort.

FRACTURE OF THE FORE ARM (ULNA, RADIUS)

• Instruct the person to sit. Position the injured arm across the chest with the thumb pointing upwards.
• Apply a padded splint to the front of the forearm, extending from the elbow to the fingers.
• Secure the splint with bandages.
  Support the arm with a sling, ensuring the fingers are pointing upwards.
• Monitor the fingers for any signs of impaired circulation.

FRACTURE OF THE PELVIS

These are typically caused by indirect force, such as in car accidents or falls from significant heights.
Pelvic fractures can be complicated by injury to the urinary bladder system.

SIGNS AND SYMPTOMS

• History of a significant injury.
  Inability to stand.
  Pain in the hips or back.
• Increased pain with movement.
• Difficulty or pain when urinating.
  Blood in the urine may be present.
• Urgency to urinate with difficulty in doing so.
• The person may exhibit signs of shock.

MANAGEMENT

• Help the person lie down with the head lower than the rest of the body.
• Keep the legs straight, or gently bend the knees and support them in that position.
• A broad bandage can be applied around the pelvis.
  Place padding between the legs and ankles and secure the legs together.
• Lift the person onto a stretcher, ensuring the pelvis is supported.

FRACTURE OF THE FEMUR

The femur, the longest bone in the body, has a rich blood supply. Fractures of the femoral neck are common in older adults, but any part of the femur can be affected.

SIGNS AND SYMPTOMS

• Intense pain.
  Shortening of the injured leg.
• The foot on the injured side may be rotated outwards.
• The person may go into shock due to the severe pain.
• The broken bone ends can damage blood vessels, leading to significant blood loss.

TREATMENT

• Help the injured person lie down while supporting the injured leg.
• Treat any signs of shock.
• Immobilize the leg by tying the knees, hips, and points above and below the fracture site together.
• Reassure the injured person.
• Arrange for transport to a medical facility.
  For long transport distances:
  Apply a padded splint from the armpit down to the foot on the outer side of the leg and a shorter splint from the groin (inner thigh) down to the foot to stabilize the injured part.
• Secure these with several bandages:
  • One across the chest.
  • One across the pelvis.
  • One above the fracture.
  • One below the fracture.
  • One securing the knees.
  • One securing the ankles.
• In some situations, a Thomas splint may be used.
• After proper immobilization, transport the person.

DISLOCATION

• A dislocation involves the displacement of bones that form a joint. Commonly affected joints include the shoulder, elbow, and jaw.

SIGNS AND SYMPTOMS

1. Severe pain at the joint.
2. Restricted movement at the joint.
3. Visible deformity of the limb.
4. Swelling, particularly if there is bleeding into the joint.

TREATMENT

1. Support the limb in the most comfortable position.
2. Relieve pain and arrange for transport to a hospital.

A SPRAIN

A sprain is an injury to a joint involving the tearing of ligaments. It can also involve injury to the surrounding soft tissues, such as tendons.

SIGNS AND SYMPTOMS

1. Intense pain initially, which gradually lessens.
2. Swelling.
3. Bruising due to blood collection at the injury site.
4. Limited movement.

TREATMENT

1. Position the limb comfortably.
2. Apply a firm bandage.
3. Apply a cold compress to reduce swelling.
4. Gently massage the muscles above the sprain.
5. Encourage gentle movement of the joint.
6. Advise the person to seek medical evaluation to rule out other injuries.

STRAIN

A strain is an injury to a muscle or tendon caused by overstretching. It may involve tearing of muscle fibers.

SIGNS AND SYMPTOMS

1. Sudden, sharp pain at the injury site.
2. Pain that worsens with movement.
3. Swelling.
4. Loss of strength or power.

TREATMENT

1. Position the person comfortably.
2. Apply a bandage or plaster to the affected area.
3. In case of suspected fracture, immobilize the area.

STITCH

A stitch is a painful spasm of the diaphragm, often occurring during physical activity like running.

TREATMENT

Rest:If rest doesn’t provide relief, offer sips of warm water and gently rub the affected area.

BITES AND STINGS

• Many insect stings cause irritation, swelling, and pain, and some can be venomous.
• Bites from sharp teeth can cause deep puncture wounds, damaging tissue and introducing germs.
• Some bites can crush tissues. Any bite that breaks the skin requires prompt first aid due to the increased risk of infection.