Title: Bone and joint injuries
Course: Level 3 - First Aid > Section: Provision of First Aid service and referral

A fracture is a break or crack in the continuity of bone

Types of Fracture

- Complete fracture- fracture involves a break across the entire cross-section of the bone and is frequently displaced (removed from normal position).
- Incomplete fracture - the break occurs through only part of the cross-section of the bone. (e.g., greenstick fracture).
- A comminuted fracture is one that produces several bone fragments.
- Closed fracture (simple fracture) is one that does not cause a break in the skin.
- Open fracture (compound, or complex, fracture) is one in which the skin or mucous membrane wound extends to the fractured bone. Can be associated with infection.

Causes of fracture: Most of the causes are motor accidents, falling accidents, pathological, recreational or sports activities.

Signs and Symptoms of Fracture

- Pain, swelling, tenderness and difficulty of moving the injured part.
- Abnormal movement in an area of the body.
- Protrusion of the broken bone ends out of the skin.
- Causality may find it difficult or impossible to move the part normally.
- Crepitus or grating sensation of broken bones due to rubbing of bone fragments against each other.
- Shortening of the affected extremity, protrusion, deformities and discoloration.

Objectives of First Aid for Fracture

- To provide all necessary first aid care.
- To keep the broken bone ends and the adjacent joints from moving.
- To give care for shock.

First Aid Principles of Fracture

- Do not move the causality unless it is necessary to avoid further injury.
- Follow the steps:
A. Clear the airway
B. Check for breathing
C. Circulatory assessment (check pulse)
- Control bleeding in an open fracture.
- Prevent movements of injured part and the adjacent joint.
- Elevate involved extremities if possible without disturbing the suspected fracture.
- If a fragment of bone is protruding, cover the entire wound with a sterile dressing.
- Don't replace any bone fragment.
- Do not wash, or do not insert your fingers into the wound.
- Apply splint (are devices applied to the arms, legs or trunk to immobilise the injured part when a fracture is suspected) and transport immediately.
- Use arm sling for an arm fracture. N.B splints should be well padded, rigid, and long enough to go along side the joint above and below the fracture.
  - Splints protect against further injury.
  - They have to be wide enough to fit the limb comfortably.

Dislocation

- Dislocation Is a displacement of a bone end from the joint particularly at the shoulder, elbow, fingers or thumb usually as a result of a fall or direct blow.
- Unless proper care is given, a dislocation may occur repeatedly.

Signs and Symptoms of Dislocation

- Swelling.
- Obvious deformity.
- Pain upon movement.
- Tenderness to touch.
- Discoloration.

First Aid Measures of Dislocation

- Splint and Immobilize the affected joint.
- Apply a sling if possible.
- Elevate the affected part if a limb is involved.
- Never attempt to reduce a dislocation.
- Seek medical help.
- N.B- Never attempt to reduce a dislocation

Sprain

- Sprain Is an injury to ligament, muscle or tendon in the region of the joint as a result of sudden wrenched or torn of these structures. Commonly occurs on ankle, knee, wrist and finger.

Signs and Symptoms of Sprain

- Swelling.
- Tenderness.
- Pain up on motion.
- Discoloration.

It is difficult to differentiate a sprain from a closed facture without an X- Ray.

First Aid Measure:

- Rest and support the injured part.
- Elevate the injured part.
- Apply cold compress.
- Support with a bandage and seek medical care.

First Aid Measures of Sprain

- If ankle or knee is affected, advice the victim not to walk.
- Raise the affected limb to prevent swelling.
- Apply a cold, wet pad.
- Splint/bandage simply.
- If swelling and pain persist, seek further medical attention.

Strains:

- Strains are injuries to muscles resulting from over stretching.
- Commonly strains occur on the back muscles due to improper lifting technique.

First Aid Measures of Strain

- Bed rest until there is no pain.
- Application of heat, warm pads.
- Use of a board under the mattress for firm support.
- Seek medical care for severe back strains.