Any break in the continuity of a bone is called a
fracture. Fractures are usually caused by an injury; occasionally they
are due to bone disease. They vary considerably in severity.
Almost in the event of fracture, there is some damage
to the surrounding tissues. The injury that caused the fracture may
badly bruise the area near the fracture. Bone ends may cut vessels,
tendons, nerves and blood vessels. the more injured part is moved, the
more damage there will be. Cut blood and lymph vessels leak into area,
causing swelling. Swelling will increase for the first 24 hrs then begin
to diminish. The blood forms an ecchymosis (a "black
and blue" spot). This goes through color changes as the
blood pigments disintegrate. The color changes from black and blue,
through green, to yellow. The pigments are finally reabsorbed into the
body. Often, ecchymosis will be away from the fracture site, as gravity
tends to pull the fluids downwards.
The muscles around the fracture go into spasm.
Usually, this serves to "splint"
the movement. Occasionally, this can actually displace the ends of the
bone, that is pull them apart.
Most often, a fracture is easy to recognize. The
broken part is twisted into an unnatural position, and the person can
move part only with difficulty or not at all. Occasionally though, there
may not be an observable deformity and movement may still be possible
and easy.
Fractures may be classified as:
Simple,
where the broken ends of the bone do not cut open the skin
Compound,
where the broken end of the bone may have cut the skin. Either the
injury that fractured the bone penetrated the skin, or the broken
end of the bone cut through the tissue and protruded through the skin.
Complicated,
where in addition to the fracture an important internal organ may
also be injured. A complicated fracture may also be simple or
compound.
First Aid
The
first thing to do is to make sure that the person can breath.
Clear the mouth of any mucus, vomitus, or blood. Make sure that
the tongue does not fall back across the wind pipe. (See Artificial
Respiration)
Next,
control bleeding: Apply direct pressure on an wound. Cover the
open wounds with a clean, preferable sterile, dressing. Do not
attempt to clean out the dirt or use an antiseptic.
Immobilization
of fractured part: This is necessary to prevent the
sharp edges of the bone from moving and cutting tissue, muscle,
blood vessels, and nerves. This reduces pain and helps prevent or
control shock. In a closed fracture immobilization keeps bone
fragments from causing an open wound and prevents contamination
and possible infection. The basic splinting principle is to
immobilize the joints above and below any fracture.
Warning:
Unless there is
immediate life-threatening danger, such as a fire or an explosion,
DO NOT move the casualty with a suspected back or neck injury.
Improper movement may cause permanent paralysis or death. In a chemical environment,
DO NOT remove any protective clothing. Apply the dressing/splint
over the clothing.
Fractures involving the back (vertebral column) require
special care. In such cases, the victim should not be allowed to get up.
Further, movement must be avoided as much as possible and emergency medical help
must be sought.
Splints,
Padding, Bandages, Slings, and Swathes:
Splints:
Splints may be improvised from such items as boards, poles,
sticks, tree limbs, rolled magazines, rolled newspapers, or
cardboard.
Padding:
Padding may be improvised from such items as a jacket,
blanket, etc or leafy vegetation.
Bandages:
Bandages may be improvised from belts or strips torn from
clothing or blankets. Narrow materials such as wire or cord
should not be used to secure a splint in place.
Slings:
A sling is a bandage (or improvised material such as a piece
of cloth, a belt and so forth) suspended from the neck to
support an upper extremity. Also, slings may be improvised by
using the tail of a coat or shirt, and pieces torn from such
items as clothing and blankets. The triangular bandage is
ideal for this purpose. Remember that the casualty's hand
should be higher than his elbow, and the sling should be
applied so that the supporting pressure is on the uninjured
side.
Swathes:
Swathes are any bands (pieces of cloth and so forth) that are
used to further immobilize a splinted fracture. Triangular and
cravat bandages are often used as or referred to as swathe
bandages. The purpose of the swathe is to immobilize,
therefore, the swathe bandage is placed above and/or below the
fracture--not over it.
Procedures for Splinting
Suspected Fractures
Ensure
that splints are long enough to immobilize the joint above and
below the suspected fracture. If possible, use at least four ties
(two above and two below the fracture) to secure the splints. The
ties should be nonslip knots and should be tied away from the body
on the splint. Splint the fracture (s) in the position
found. DO NOT attempt to reposition or straighten the injury. If
it is an open fracture, stop the bleeding and protect the wound.
Figures
below shows the proper way in which splinting should be done for
various position and note that the knots are away from the body of
splints:
Improvised
splints for lower arms using a pillow when no board or
similar rigid material is available.
Improvised
splints for lower arms using newspapers when no board or
similar rigid material is available.
Improvised
splints for arm and hand using a board. The arm must be
supported by a sling. A second board (one on either side of bone) can
also be used.
A large hairpin makes a handy
emergency splint for a broken finger. Tape it securely for the
trip to the doctor.
If you suspect that someone's foot is
fractured, Do Not Remove the Shoe. Place
a board beneath the sole and tie it to the shoe. Do
not permit the patient to walk on foot. Carry him or transport
him on stretcher.
Left: Improvised
splint for fracture of leg. A piece of board is wrapped in
cloth for cushioning. One end of cloth may be brought around the foot.
Four seperate strips of cloth, fastened with square knots, hold the
splint in place.
Right: For
this splint, a rod or stick is tied around the leg, which was given a
protective wrapping of cloth.
How to make a Triangular and Cravat (Swathe) Bandages
Triangular and cravat (or swathe) bandages are fashioned
from a triangular piece of muslin (37 by 37 by 52 inches) provided in the
general purpose first aid kit. If it is folded into a strip, it is called a
cravat. Two safety pins are packaged with each bandage. These bandages are
valuable in an emergency since they are easily applied.
To improvise a triangular bandage, cut a square of available
material, slightly larger than 3 feet by 3 feet, and FOLD it DIAGONALLY. If
two bandages are needed, cut the material along the DIAGONAL FOLD. A cravat
can be improvised from such common items as T-shirts, other shirts, bed
linens, trouser legs, scarfs, or any other item made of pliable and durable
material that can be folded, torn, or cut to the desired size.
Labeled with ICRA