1. FRACTURES

3. What Is A Fracture?
A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either OPEN or CLOSED

4. Open Fracture
(Also called COMPOUND fracture.) - the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.

5. Closed Fracture
(Also called SIMPLE fracture.) - the bone is broken, but the skin is intact.

6. Fracture Names
GREENSTICK - incomplete fracture. The broken bone is not completely separated.
TRANSVERSE - the break is in a straight line across the bone.
SPIRAL - the break spirals around the bone; common in a twisting injury

7. Fracture Names OBLIQUE - diagonal break across the bone.
COMPRESSION - the bone is crushed, causing the broken bone to be wider or flatter in appearance.
COMMINUTED - the break is in three or more pieces and fragments are present at the fracture site.
SEGMENTAL - the same bone is fractured in two places, so there is a “floating” segment of bone.

8. What Causes a Fracture?
Fractures occur when there is more force applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body

9. Symptoms PAIN in the injured area SWELLING in the injured area
OBVIOUS DEFORMITY in the injured area
DIFFICULTY using or moving the injured area in a normal manner
WARMTH, bruising, or redness in the injured area
The symptoms of a broken bone may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

10. Symptoms A visibly out-of-place or misshapen limb or joint
Swelling, bruising, or bleeding
Intense pain
Numbness and tingling
Broken skin with bone protruding
Limited mobility or inability to move a limb

11. Common Causes Fall from a height Motor vehicle accidents Direct blow
Child abuse
Repetitive forces, such as those caused by running, can cause stress fractures of the foot, ankle, tibia, or hip

12. First Aid
Check the person’s airway and breathing. If necessary, begin rescue breathing, CPR, or bleeding control.
Keep the person still and calm.
Examine the person closely for other injuries.
If the skin is broken, it should be treated immediately to prevent infection. Don’t breathe on the wound or probe it. If possible, lightly rinse the wound to remove visible dirt or other contamination, but do not vigorously scrub or flush the wound. Cover with sterile dressings.

13. First Aid
If needed, immobilize the broken bone with a splint or sling. Possible splints include a rolled up newspaper or strips of wood. Immobilize the area both above and below the injured bone.
Apply ice packs to reduce pain and swelling.
Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches above the head, and cover the person with a coat or blanket. However, DO NOT move the person if a head, neck, or back injury is suspected.

14. Check Blood Circulation
Check the person’s blood circulation. Press firmly over the skin beyond the fracture site. (For example, if the fracture is in the leg, press on the foot). It should first blanch white and then “pink up” in about two seconds. Other signs that circulation is inadequate include pale or blue skin, numbness or tingling, and loss of pulse. If circulation is poor and trained personnel are NOT quickly available, try to realign the limb into a normal resting position. This will reduce swelling, pain, and damage to the tissues from lack of blood.

15. Treat Bleeding Place a dry, clean cloth over the wound to dress it.
If the bleeding continues, apply direct pressure to the site of bleeding. DO NOT apply a tourniquet to the extremity to stop the bleeding unless it is life-threatening.

16. Do Not Move the person unless the broken bone is stable.
Move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you must move the person, pull the person to safety by his clothes (such as by the shoulders of a shirt, a belt, or pant-legs).
Move a person who has a possible spine injury.
Attempt to straighten a bone or change its position unless blood circulation appears hampered.
Try to reposition a suspected spine injury.
Test a bone’s ability to move.
Call immediately for emergency medical assistance

17. Take Special Care if
There is a suspected broken bone in the head, neck, or back.
There is a suspected broken bone in the hip, pelvis, or upper leg.
You cannot completely immobilize the injury at the scene by yourself.
There is severe bleeding.
An area below the injured joint is pale, cold, clammy, or blue.
There is a bone projecting through the skin.

18. Take Special Care if
Even though other broken bones may not be medical emergencies, they still deserve medical attention. Call your health care provider to find out where and when to be seen.
If a young child refuses to put weight on an arm or leg after an accident, won’t move the arm or leg, or you can clearly see a deformity, assume the child has a broken bone and get medical help.

19. Prevention
Wear protective gear while skiing, biking, roller blading, and participating in contact sports. This includes helmets, elbow pads, knee pads, and shin pads.
Create a safe home for young children. Gate stairways and keep windows closed.
Teach children how to be safe and look out for themselves.

20. Prevention
Supervise children carefully. There is no substitute for supervision, no matter how safe the environment or situation appears to be.
Prevent falls by not standing on chairs, counter tops, or other unstable objects. Remove throw rugs and electrical cords from floor surfaces. Use handrails on staircases and non-skid mats in bathtubs. These steps are especially important for the elderly.

21. Bones
Bones are a form of connective tissue, reinforced with calcium and bone cells. Bones have a softer centre, called marrow, where blood cells are made. The main functions of the skeleton include support, movement and protection of vulnerable internal organs. There are different types of bone fractures that vary in severity. Factors that influence severity include the degree and direction of the force, the particular bone involved, and the person’s age and general health. Common sites for bone fractures include the wrist, ankle and hip. Hip fractures occur most often in elderly people. Broken bones take around four to eight weeks to heal, depending on the age, health of the individual, and the type of break.

22. Types of Bone Fractures
GREENSTICK fracture - the bone sustains a small, slender crack. This type of fracture is more common in children, due to the comparative flexibility of their bones.
COMMINUTED fracture - the bone is shattered into small pieces. This type of complicated fracture tends to heal at a slower rate.
SIMPLE fracture - or ‘CLOSED’ fracture. The broken bone hasn’t pierced the skin.
COMPOUND fracture - or ‘OPEN’ fracture. The broken bone juts through the skin, or a wound leads to the fracture site. The risk of infection is higher with this type of fracture.
PATHOLOGICAL fracture - bones weakened by various diseases (such as osteoporosis or cancer) tend to break with very little force

23. Types of Bone Fractures
AVULSION fracture - muscles are anchored to bone with tendons, a type of connective tissue. Powerful muscle contractions can wrench the tendon free, and pull out pieces of bone. This type of fracture is more common in the knee and shoulder joints.
COMPRESSION fracture - occurs when two bones are forced against each other. The bones of the spine, called vertebrae, are prone to this type of fracture. Elderly people, particularly those with osteoporosis, are at increased risk.
COMPLICATED fractures: Besides damage to the bones it involves damage to vital organs, major blood vessels, spinal chord

24. Complications
SHOCK - bones have a rich blood supply, and a bad break can result in substantial blood loss.
INJURIES TO ORGANS - such as the brain (in the case of skull fractures) or chest organs (if a rib breaks).
GROWTH PROBLEMS - the fractured long bone of a young child may not grow to its intended adult length if the injury is close to a joint, since bone fuses when it heals.

25. First Aid
Suggestions for immediate treatment of a suspected bone fracture include:
Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing.
Cover the wound.
Apply a splint, making sure to hold the affected area in a comfortable position.
Talk gently to the person and reassure them.
Seek medical help immediately.

26. Diagnosis and Treatment
Bone fractures are diagnosed with X-RAYS. CT and MRI scans may also be used. Broken bones heal by themselves - the aim of medical treatment is to make sure the two pieces are lined up correctly. Subsequent x-rays are taken to monitor the bone’s healing progress. Depending on the site of the fracture and the severity of the injury, treatment options may include:
Splints - to discourage movement of the broken limb.
Braces - to support the bone.
Plaster cast - to provide support and immobilise the bone.
Traction - this option is less common.
Surgically inserted metal rods or plates - to hold the bone pieces together.

27. Things to Remember
A fracture occurs when force exerted against a bone is stronger than the bone can structurally withstand.
The most common sites for bone fractures include the wrist, ankle and hip.
Treatment options include immobilising the bone with plaster casts, or surgically inserting metal rods or plates to hold the bone pieces together.

28. The healing process
The blood clots that form on the broken ends of bone are the beginning of the healing process. Over five or so weeks, the body fuses the two bone portions together with a combination of fibrous cells and cartilage. This bridge is temporary and not as strong as real bone. It can break easily with comparatively little force. The cast or splint may be removed after a few weeks, but the bone still needs to be handled with care for at least one more month. The temporary bone (‘callus’) is slowly replaced with real bone over the next couple of months. Unlike skin, broken bones heal without forming scar tissue. However, immobilised muscles tend to weaken and wither. Rehabilitation, including strengthening exercises, may be needed for a short time.