Fractures and Sprains

Bone and joint injuries: assessment and stabilization.

Types of Injuries

Fractures (Broken Bones)

Sprains

Ligament injury (connects bone to bone)

• Mild: Stretched
• Moderate: Partially torn
• Severe: Completely torn

Strains

Muscle or tendon injury (connects muscle to bone)

• Overstretched or torn muscle fibers

Dislocations

Joint comes out of normal position

• Very painful
• Obvious deformity
• Cannot move joint normally

Recognizing Bone/Joint Injuries

Signs and Symptoms

Fracture vs. Sprain?

You often can't tell without X-ray. When in doubt, treat as fracture.

Suggestive of fracture:

• Heard a snap
• Obvious deformity
• Bone visible
• Severe pain even at rest
• Immediate inability to use

General Treatment: RICE

For most musculoskeletal injuries:

Ice Application

• 20 minutes on, 20 minutes off
• Barrier between ice and skin (cloth)
• Don't apply directly to skin (frostbite risk)
• Most helpful in first 48 hours

Splinting

When to Splint

• Suspected fracture
• Dislocation
• Severe sprain
• Before moving victim

Splinting Principles

Goals:

• Immobilize injury
• Prevent further damage
• Reduce pain
• Protect for transport

Rules:

1. Splint in position found (don't straighten)
2. Immobilize joint above AND below fracture
3. Pad bony prominences
4. Check circulation before and after
5. Don't apply over open wound (cover wound first)

Circulation Check

Before and after splinting, check:

• Pulse below injury
• Skin color (pink vs. pale/blue)
• Skin temperature (warm vs. cold)
• Sensation (can they feel touch?)
• Movement (can they wiggle fingers/toes?)

If circulation compromised after splinting:

• Loosen splint immediately
• Recheck

Improvised Splints

Specific Injuries

Arm/Forearm Fracture

1. Support arm in position found
2. Apply padded splint from shoulder to beyond wrist
3. Include hand in comfortable position
4. Secure with bandages (avoid fracture site)
5. Support with sling

Wrist/Hand Fracture

1. Place padding in palm (roll of gauze)
2. Apply splint from forearm past fingertips
3. Secure with bandages
4. Support with sling

Finger Fracture

1. Buddy tape: Tape injured finger to adjacent finger
2. Place padding between fingers
3. Check circulation

Leg Fracture

Upper leg (femur):

• Very serious, significant blood loss possible
• Immobilize entire leg and hip
• Pad between legs
• Secure both legs together
• Call 911 (needs traction splinting)

Lower leg:

1. Apply padded splint from thigh to beyond foot
2. Include foot in natural position
3. Secure above and below fracture site
4. Check circulation at foot

Ankle Fracture

1. Splint in position found
2. Pillow splint works well (wrap around ankle, secure)
3. Elevate
4. Ice if available

Knee Injury

1. Immobilize in position found
2. Long splints from hip to ankle
3. Pad behind knee
4. Don't straighten if bent

Shoulder/Collarbone

1. Support arm against body
2. Apply sling
3. Secure arm to body with bandage (swathe)

Pelvis Fracture

Serious emergency. Internal bleeding likely

1. Call 911 immediately
2. Don't move unless necessary
3. Treat for shock
4. Place padding between legs
5. Tie legs together gently (ankles, knees, thighs)
6. Monitor vital signs

Skull/Spine

See chapter on head/spinal injuries (special protocols)

Open Fractures

Bone visible or protruding through skin.

Treatment:

1. Call 911
2. Control bleeding around wound (not on bone)
3. Cover wound with sterile dressing
4. Don't push bone back in
5. Stabilize without pushing on bone
6. Treat for shock
7. Monitor

Dislocations

Do NOT attempt to relocate. This requires medical training.

Treatment:

1. Immobilize in position found
2. Apply ice to reduce swelling
3. Support comfortably
4. Transport to medical care

Common dislocations:

• Shoulder
• Finger
• Knee
• Hip

When to Seek Medical Care

Call 911 for:

• Open fracture
• Suspected spinal injury
• Suspected pelvis or hip fracture
• Femur fracture
• Signs of shock
• Loss of circulation below injury

Seek same-day care for:

• Any suspected fracture
• Dislocation
• Severe sprain
• Unable to bear weight
• Significant deformity
• Numbness or tingling

Can wait for regular appointment:

• Mild sprain with no deformity
• Minor strain
• Improving symptoms

Sprain and Strain Home Care

First 48-72 hours:

• Rest injured part
• Ice 20 minutes every 2-3 hours
• Compression with elastic bandage
• Elevate when possible
• Over-the-counter pain medication

After 72 hours:

• Gentle movement
• Heat may help
• Gradual return to activity
• Physical therapy if severe

Warning signs (seek care):

• No improvement in 3-5 days
• Worsening symptoms
• Inability to bear weight
• Significant swelling
• Numbness

Key Points

1. When in doubt, treat as fracture - You can't tell without X-ray
2. Don't straighten deformed limbs - Splint in position found
3. Immobilize joints above and below - Prevents movement
4. Check circulation - Before and after splinting
5. Open fractures are emergencies - Call 911
6. Don't relocate dislocations - Requires medical training
7. RICE for most injuries - Rest, Ice, Compression, Elevation
8. Pelvis and femur fractures are serious - Internal bleeding risk