Management of fractures

When a bone is broken it is fractured. Fractures, particularly of large bones (like the thigh bone) are an emergency. You can help by knowing what to do. Signs and Symptomps

Deformity, swelling and pain Altered sensation (e.g. pins and needles) Inability to move the limb normally

How can you help

Control any external bleeding using direct pressure over the wound Call for an ambulance if the patient is in severe pain, or if the bone is sticking through the skin, or if they cannot walk Assist the patient into a comfortable position Support the limb e.g. with a pillow, but do not move the limb unnecessarily

If the ambulance is going to be delayed, or you are in an isolated area, you may have to splint or sling the affected limb to stabilise it. If it is necessary to move the casualty, follow these guidelines:

Seek medical aid, call for an ambulance Immobilise all fractures before moving a casualty Immobilise the limb above and below the site of the fracture with padded splints and tie off on the uninjured side with triangular bandages or any other suitable item Make sure that the ties holding the splint in position are firm but not too tight Towels and/or blankets can be used as improvised splints if necessary support the fracture A sling may be used to do this?

Image above: Leg fracture immobilisation

Image above: Improvised splints

When in doubt, splint the injured limb as it is better to over-treat than not treat at all

Elevate the limb if possible. When elevating the limb make sure it is well supported Listen to the casualty, they feel the pain and are the best person to judge if they are in a comfortable position or not Make sure that the ties are firm but not too tight In the absence of other splints the body can be used as a splint

Severely angulated fractures should be straightened only if:

There is no circulation to the lower part of the limb that is broken Medical aid is not available and you have to transport the casualty out of a remote location (e.g. placing a casualty with an angulated leg fracture onto a stretcher will be extremely difficult unless the leg is straightened)

If you have to straighten a limb, be careful to provide support above and below the fracture site:

You only want to achieve the return of circulation, so it is not necessary to attempt total realignment of the limb Never straighten fractures at joints because it may cause damage to the many nerves and blood vessels that run through the joint If you do use an improvised splint (such as a piece of wood), always ensure that the splint extends further than the length of the limb

Key points for leg fracture immobilisation:

With leg fractures it is important to provide adequate padding in the natural hollows found when you place the legs together Always position all bandages before tying off The key to immobilisation of a leg fracture is the figure 8 bandage that is placed around the feet this is always tied off first

St John. 2010. http://www.stjohn.org.nz/tips/fractures.aspx Accessed at 12th December 2010. 13.46 Surf Life Saving Australia. 2009. http://beachsafe.org.au/Company/First_Aid_Info/Management_of_fractures_and_slings Accesssed at 13 December 2010. 18.55