If a casualty has an injury to their bones, muscles or joints, your aim as a first aider is to prevent further injury.
Because of the similar signs and symptoms, it may be difficult for the first aider to recognise the difference between a fracture, dislocation, strain or sprain. A first aider is not expected to make a diagnosis. The important thing is that you recognise a serious injury to the bone, muscle or joint and arrange appropriate medical treatment.
Broken bones are usually caused by considerable direct or indirect force, but might require less force in an elderly casualty or those with osteoporosis (brittle bone disease).
Broken bones might range from relatively minor breaks such as fingers or toes, to major breaks that are potentially life threatening such as the pelvis, where complications to surrounding organs and the blood supply leads to internal bleeding.
Breaks are usually closed, where the bone remains within the body, but can sometimes become open where the bone has broken the skin and become exposed.
In younger children, it is common to see ‘green stick’ breaks where the bone has bent and fractured but not snapped completely. This is because the younger we are, the lower density our bones, and therefore there is greater flexibility.
A dislocation is where a joint is fully or partially pulled out of position. Common sites of dislocation included the knee, hip, shoulder or fingers.
Strains and sprains are injuries to muscles, tendons and ligaments. They are usually caused by overstretching or forceful twisting of a joint.
Possible Signs and Symptoms:
- Pain and tenderness
- Irregularity
- Swelling and bruising
- A grating sensation or noise from the bone ends rubbing together (crepitus)
- Loss of power or use of a limb
- A shortening of the limb
- Shock
Treatment:
- Tell the casualty to keep as still as possible
- If possible, elevate and support the injury
- Immobilise to avoid further movement. Immobilise only if it will not cause further pain or damage. Immobilisation may just be padding or supporting the injury.
- If appropriate, apply an ice pack or cold compress. This will help control swelling. Wrap the ice pack in a towel or similar to avoiding contact with the skin. Keep the ice pack in place for 10 minutes at a time.
- Keep the casualty warm
- Nothing to eat or drink
- Treat for shock if needed
- Call for an ambulance unless minor
- Never attempt to reposition or relocate a dislocation – it is likely to cause severe pain and even further injury.
- Additionally, for an open fracture; cover any open wounds with a clean (preferably sterile) dressing
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