Fractures: First-aid and treatment

A fracture occurs when the bones counter a strong force (usually stronger than they can bear). Though the most common causes are trauma due to a fall/fight/vehicular accident etc., they may also be caused when the bones get weak due to conditions like osteoporosis (in old age mostly), brittle bone disease, osteomalacia etc.

How do I know it’s a fracture?

• A loud snapping or cracking sound during an accident.
• Severe pain in the injured area, which increases on trying to move that part of the body.
• Inability to use that part of the body or loss of function.
• Bruising, swelling and tenderness of the injured area.
• An obvious deformity, such as the foot and leg rotated in the wrong direction in the case of fracture in the leg, or a bent wrist in case of a wrist fracture.
• A bone sticking out of the skin.
• Numbness or change in the color of the skin (bluish tinge) at the extreme end of the involved part, such as the fingertips in case of fracture of the arms.
• In case of a hip fracture, inability to put one’s weight on the leg or on the affected side.

If you realize that you or the injured person has a fracture, the first thing you should do is to call for emergency help. Until help arrives you can administer some first aid to the injured area.

What first-aid can I give the person who suffers from a fracture in my presence?

• Do no harm: Never moves the patient or the affected part, unless you need to do so to prevent further emergency.
• Administer CPR: If the patient is unconscious, is not breathing and has no signs of a pulse, administer cardiopulmonary resuscitation or CPR. It is a systematic method of reviving a patient using alternate mouth to mouth breathing and chest compressions. But be cautious if you suspect the patient to have a fracture in the back of the neck. Then you should not try to tilt the head of the person back to maintain the airway; instead try to thrust the jaw forward with the help of your fingers.
• Be alert about the person’s breathing: If the patient is in shock, i.e. he/she faints or has shallow and rapid breathing and his/her skin turn pale. Make the patient lie on his/her back and raise the legs by a few inches. Avoid this if you think he/she has a fracture in the leg.
• Try to stop bleeding: This could be done by applying pressure at the bleeding point with a clean piece of cloth or gauze.
• Try to stabilize the fractured part(s): This can be done by applying a splint to the fractured part(s).The splint can be in the form of a piece of metal, wood or plastic that has been padded (the padding will reduce discomfort). The main function of the splint is to prevent the movement of the fractured part.
• Do not attempt anything drastic: This means that you should not try to push back a bone that has come out through the skin. Apart from causing immense pain, it could cause more damage than good.
• Help with the pain: Apply ice packs to the fractured area to reduce swelling and tenderness.

When you finally reach a doctor’s office, the physician will do a careful physical exam of the injury and order diagnostic tests of the injured area to assess the type and extent of the fracture. The investigations may be in the form of routine X-rays or CT scans, MRI, angiogram, etc.

How is the fracture treated?

Whatever the fracture may be, after proper alignment or ‘reduction’ the fracture fragments will be immobilized and kept in position for a certain period of time in order to heal. The immobilization may be done with the help of a plaster of Paris cast, splint or traction.

In certain fractures, a minor surgery may be required (also called an open reduction) and metallic plates, rods, screws or pins are used to stabilize the bone fragments in position. Sometimes when the bone fragments are damaged beyond repair, then the doctor may choose to replace the damaged bone fragments with a metallic prosthesis.

Some amount of physical therapy is required during the period of immobilization in order to prevent medical complications. After the period of immobilization is over, one should gradually start to use that portion of the body in order to gain complete strength. This may take a few weeks to a few months, depending on the type and location of injury and the age of the patient.