First Aid - Fractures

A broken bone due to accident less often from overwork or bone disease itself. All fractures will cause a light internal bleeding since the tissues are damaged.

BROKEN BONES (FRACTURES)

When a bone is broken, the most important thing to do is keep the bone in a fixed position. This prevents further damage and lets it mend.

Before trying to move or carry a person with a broken bone, keep the bones from moving with splints, strips of bark, or a sleeve of cardboard. Later a plaster cast can be put on the limb at a health center, or perhaps you can make a cast according to local tradition.

Setting broken bones: If the bones seem more or less in the right position, it is better not to move them this could do more harm than good.

If the bones are far out of position and the break is recent, you can try to set or straighten them before putting on cast. The sooner the bones are set, the easier it will be. Before setting, if possible inject or give diazepam to relax the muscles and calm pain. Or give codeine.

HOW LONG DOES IT TAKE FOR BROKEN BONES TO HEAL?

The worse the break or the older the person, the longer healing takes. Children's bones mend rapidly. Those of old people sometimes never join. A broken arm should be kept in a cast for about a month, and no force put on it for another month. A broken leg should remain in a cast for about 2 months.

SIMPLE OR CLOSED FRACTURES:

One where no open wounds show the broken bone point, & no danger of contamination from outside.

COMPLICATED OR OPEN FRACTURE:

Where a wound shows the place where the bone is broken. Then there is a great danger for infection to the bone with grave consequences. This wound MUST be bandaged.
The rescuer who suspects a fracture MUST try to get details on the cause from withesses or the victim if it is possible.

SYMPTOMS:

Swelling, localised pain, unable to stir the wounded part, sensibility to the touch of the wounded part. Deformation or abnormal position, wounds.
Grievous fractures can at times present very little signs or symptoms.
A fracture can cause very little pain as long as the victim stays immobile.
If you suspect a fracture of the foot or leg don't make the victim walk to MAKE SURE, you could cause aggravation.
We have seen people able to walk with fractured legs while others could not move yet without any fracture. When in doubt, treat it as if there was fracture.

FIRST-AID GOALS:

1) Prevent a simple fracture to become worst as a complicated one by a handling without precaution of the victim or by the pressure of a splint on a broken bone piece or fragment.
2) Stop or prevent infection of a complicated fracture.
3) Treat the other causes of the accident ex: shock, haemorrhage.
4) Prevent that slashed bones cause other internal injuries.
5) Move the victim from the scene using the best method.

GENERAL RULES:

1) During all the operation, the greatest precautions MUST be taken to prevent complication and give pain relief.
2) Immobilise the fracture & the articulations above and below the fracture with a splint or with the body or victim's limbs.
3) Splint at the place where the victim lies.
4) ALWAYS splint the fracture in the most comfortable position for the victim.
5) An appropriate mean of transport will prevent aggravation.
6) Note: Ask the victim if you can help & respect his decision.

FREQUENT FRACTURES:

Lower jaw fractures are frequents, the shin can appear dislocated. Usually there is blood in the mouth, & jaw moving is painful.
1) Transport the victim in semi-prone position or sitting to nearest hospital, doctor or dentist.
2) Verify if respiratory channels are free, &maintain them free. Bandages are not necessary, the victim will protect himself.

FOREARM - HAND - WRIST:

1) Apply softly 2 splint well padded & long enough to bypass the elbow and wrist articulation.
2) Wrap narrow bandages to insure a good immobilisation, yet letting free the finger tips to verify the circulation if the thumb is not wounded, keep it off the bandage.
3) Slide the arm in a Grand arm-sling.
4) The chest can often be used as a grand splint.
5) In emergency, Rolled newspaper or magazine do an excellent job as splints to immobilise a broken arm.

HOW TO SET A BROKEN WRIST

Pull the hand with a slow, steady force for 5 to 10 minutes, increasing the force, to separate the bones.

With one person still pulling the hand, have another gently line up and straighten the bones.

WARNING: It is possible to do a lot of damage while trying to set a bone. Ideally, it should be done with the help of someone with experience. Do not jerk or force.

UPPER ARM OR HUMERUS:*

1) Place the arm in a small arm-sling. This permits the elbow to move freely and to apply a natural pressure on the broken bone.
2) Place a good padding if necessary between the elbow & the chest to assure a proper alignment.
3) Put a Grand sling on the elbow as indicated for collar-bone fracture. The body is used as a great splint.

BROKEN THIGH OR HIP BONE

A broken upper leg or hip often needs special attention. It is best to splint the whole body like this:

and to take the injured person to a health center at once.

BROKEN NECKS AND BACKS

If there is any chance a person's back or neck has been broken, be very careful when moving him. Try not to change his position. If possible, bring a health worker before moving him. If you must move him, do so without bending his back or neck. For instructions on how to move the injured person, see the next page.

BROKEN RIBS

These are very painful, but almost always heal on their own. It is better not to splint or bind the chest. The best treatment is to take aspirin or acetaminophen (avoid giving aspirin to children) and rest. To keep the lungs healthy, take 4 to 5 deep breaths in a row, every 2 hours. Do this daily until you can breathe normally. At first, this will be very painful. It may take months before the pain is gone completely.

A broken rib does not often puncture a lung. But if a rib breaks through the skin, or if the person coughs blood or develops breathing difficulties (other than pain), use antibiotics (penicillin or ampicillin) and seek medical help.

RIBS FRACTURES:
A blow, a fall, a strong pressure even a sneezing can cause a fracture of one or many ribs.
The respiration is done with pain, more pronounced with deep breathing or coughing.
1) Bandages are not necessary because the victim will by itself take the position to breath with lesser pain.
2) Advise the victim to see his doctor.
3) Place the victim on his wounded side, in semi-prone position. The good lung will then be up-lifted, will work with double strength & the wounded part will be immobilised.
4) This position prevents all internal bleeding to penetrate in the lung unaffected.

COMPLICATIONS OF RIB FRACTURES:
Perforation of the lung. A sharp fragment of the broken rib can penetrate the lung. There can be signs or symptoms of internal haemorrhage and coughing can bring out some blood.

COMPLICATED FRACTURES OF THE RIBS:
Grave complication because the infection can swarm the wound & spread to all the chest.

FIRST-AID: 

Apply a clean bandage & observe general rules above.

BREATHING WOUND IN THE CHEST:

It is the gravest complication of the complicated fractures. A most frequent wound in war time & in peace time due to careless use & handling of firearms.
The fractured ribs have penetrated in the chest & each respiration brings air in and out. The shock state is considerable. The lungs are wounded & often the heart also. It can cause death in a few minutes.

1) CLOSE THE WOUND BY ANY MEANS.
Using a piece of plastic, an adhesive dressing, even your hand.
(Note about Saran Wrap) **
2) Put the victim on his wounded side in semi- prone position.
3) Give him all the possible comfort.
4) Bring him to nearest hospital on a stretcher & ambulance.

COLLAR BONE:

Frequents & caused by a fall on the hand stretched out or a fall on the shoulder end.
Since the collar bone does the tension to maintain shoulders straight, this fracture will lower the shoulder front-ward on the wounded side.
The pain is not very strong & the victim can usually support his forearm on his chest with the help of his other hand.
1) Use a St. John arm sling on the wounded arm.
2) A wide bandage put over the wounded side elbow, and going around the body and knotted at the front on the opposite side will immobilise the shoulder.

SHOULDER BLADES: 

Same F/Aid as Collar-Bone

BROKEN BONES THAT BREAK THROUGH THE SKIN (OPEN FRACTURES)

Since the danger of infection is very great in these cases, it is always better to get help from a health worker or doctor in caring for the injury. Wear gloves or plastic bags on your hands

and clean the wound and the exposed bone very gently but thoroughly with cool, boiled water. Cover with a clean cloth. Never put the bone back into the wound until the wound and the bone are absolutely clean.

Splint the limb to prevent more injury.

If the bone has broken the skin, use an antibiotic immediately to help prevent infection: penicillin, ampicillin, or tetracycline.

CAUTION: Never rub or massage a broken limb or a limb that may possibly be broken

PELVIS:

Frequent fracture due to accidents & jumping. Signs & symptoms: 1) The victim can't stand up nor walk, nor dance.
2) Laid on his back, he is unable to rise his legs while keeping his knees straight.
3) He can have blood coming from his rectum or in his urine.

FIRST-AID:

1) You MUST move him with greatest care to avoid aggravation.
2) Lay the victim comfortably on his back.
3) Immobilise the legs by tying his feet & ankles using a bandage in shape of "8" & with a large bandage around his knees.
If long splints are available, immobilise the whole body from under the arm pit down to the feet.
4) Bring to hospital, use ambulance or stretcher "rigid, hard."
5) Tell the doctor if presence of blood in urine or rectum.
6) Tell the victim not to piss.

HIP (THIGH BONE OR FEMUR): 

Longest human bone.
Except for elder people, it needs a very strong blow to break it.
An internal haemorrhage usually goes with a broken Femur.

SIGNS & SYMPTOMS:

1) Limb can't be moved without pain.
2) The leg can have a tendency to roll on the outside, the foot turned on the side.
3) The leg can appear shorter.

FIRST-AID: 

If easy to get medical help etc. proceed simply by:
1) Lift up the victim with precaution so as not to stir the broken limb.
2) Put him on a "rigid" stretcher for transport.

TRACTION: (FRACTURE WITH SPASMS) *

1) If you can determine the time factor to be in the first 5 minutes of the accident, then you can do the traction. If the time factor is from 4 to 15 min after the accident ask the victim if you can do the traction, tell him why but his decision is without appeal
If after 20 min. You MUST NOT do the traction. If the bone is pricking trough the skin, you MUST NOT in any case do the traction.
2) If the victim MUST be transported far or trough rough road:
A) Stretch the unwounded leg along with the sick one.
B) Once the injured legs is split, tie it with the good one.

WHY IMMOBILISE A FRACTURE: USE of SPLINTS: 

It MUST be immobilise so that the broken bone & its sharpness can not cut the tissues, muscles or nerves or broken blood vessels.
Beside Immobilisation reduce greatly the pain, prevents shock state, & prevents bones fragments to create an open fracture from a closed one thus inviting germs & infection to get in.
Make the splint where you find the victim, Before moving the person or transporting him elsewhere. Don't try to correct a bone or articulation.