Skeletal and Soft Tissue Injuries

SEO Key Takeaways – Skeletal & Soft Tissue Injuries (CPR First Aid)

1. Fractures Defined: A fracture is a break in a bone, classified as closed, open, or complicated, with each type requiring specific first aid responses.

2. Closed Fractures: Bone remains under the skin; immobilisation and medical assessment are essential to prevent further injury.

3. Open Fractures: Bone protrudes through the skin, increasing infection risk; control bleeding and avoid moving the bone.

4. Complicated Fractures: Fractures causing additional organ injury (e.g., punctured lung) require urgent professional care.

5. Dislocations: Joints displaced from their normal position; do not attempt repositioning. Support the limb, apply ice, and seek immediate medical attention.

6. Sprains vs. Strains: Sprains involve ligament overstretching; strains involve muscle or tendon overextension. Both present pain, swelling, and reduced function.

7. RICER Method: For sprains and strains, follow Rest, Ice, Compression, Elevation, Referral to aid healing and reduce complications.

8. Avoid H.A.R.M. Post-Injury: Heat, Alcohol, Running, and Massage in the first 48–72 hours can worsen swelling and delay recovery.

9. Bruise Management: Apply rest and ice for contusions to reduce swelling and promote healing; monitor for severe signs.

10. General First Aid Principle: Immobilise, support, monitor, and seek professional medical help—proper first aid prevents complications and improves recovery outcomes.

Fractures

A fracture is a medical term to describe any break in the cortical surface of a bone. It should be clarified that a break and a fracture are the same thing. Fractures can occur through various mechanisms, such as a direct blow to a bone (motor vehicle accident or being punched in the face).

Types of Fractures

First aiders need to be aware of the three main classifications of fractures.

• Closed fracture
• Open Fracture
• Complicated fracture

A closed fracture refers to a break with no penetration through the skin. This is the simplest type of fracture.

An open fracture is the penetration of the bone through the skin (e.g. a bone sticking out of a casualty’s arm). These fractures have a significantly increased chance of wound and bone infection.

A complicated fracture is any fracture that has caused additional organ complications. A fractured rib can be a simple closed fracture, but if it punctures the lung or an abdominal organ such as the spleen, this becomes complicated as secondary injuries can be extremely severe.

First aid for the three types of fractures is different, so it is essential to learn about each type.

Signs and Symptoms

However, there are some signs and symptoms to look out for. Not all listed are specific to fractures, but a combination of the following may indicate a fracture.

• A loud snap or crack heard by yourself or the casualty
• An obvious deformity will most likely indicate a fracture
• A shortening of the injured limb
• Loss of movement or extreme pain on touching the injured area or when attempting to move the part
• Unable to put weight on an injured
• The amount of swelling is not always an indication of the severity of the injury. However, it should be assumed that there is an underlying injury when there is significant swelling.
• It can be challenging to judge the extent of an injury based purely on the level of pain indicated by the casualty. In some cases, a person can walk away with a fractured ankle, whereas in other cases, a casualty may be in hysterical pain with no significant damage to the part.
• If a fracture is suspected, correct first aid treatment can prevent further injury, assist in healing, and help reduce pain by immobilising the patient.

Fracture Treatment

How would you treat a casualty with a fracture? First aid for a suspected fracture involves three basic principles:

1. Immobilisation, support, and elevation of the injured part
2. Assessing and treating the casualty’s condition, e.g., shock, bleeding, or other injuries.
3. Obtaining a prompt medical opinion for diagnosis and further treatment

Remember: As first aiders, we don’t fix problems. That is the job of the professionals. (Refer to the image)

Do’s and Don’ts for Fracture

When someone sustains a fracture, immediate care is essential to prevent further injury and ensure their safety until professional help arrives. Avoid moving the injured person unless necessary, and follow these critical first aid steps:

1. Control Bleeding

If the injury involves an open wound, apply gentle pressure using a sterile bandage, clean cloth, or clothing to slow the bleeding.

2. Immobilize the Injury

It is crucial to keep the fractured area still. Do not attempt to realign the bone or push a protruding bone back in place, as this could cause further damage. If you are trained in splinting and medical help is delayed, you can apply a splint to stabilise the area above and below the fracture. Adding padding can help ease discomfort.

3. Reducing Swelling and Pain

To minimise swelling and relieve pain, apply an ice pack wrapped in a cloth or towel to the injured area. Never place ice directly on the skin, which can cause frostbite or skin damage.

4. Watch for Signs of Shock

If the person appears weak, dizzy, or breathing rapidly, they may experience shock. Lay them down with their head slightly lower than their trunk, and if possible, elevate their legs to improve circulation.

5. Stay Calm and Seek Medical Help

Although this may seem obvious, you should handle the injured part carefully. Careless handling of a fractured limb can cause extreme pain and could also send the casualty into shock. Finishing a first aid course can help avoid the incorrect management of ankle sprains, hamstring strains, and other possible effects of sports injuries.

Dislocations

A dislocation involves the bones of a joint being displaced from their normal position. As the bones move out of position, the attached ligaments are also overstretched, and hence, a strain can also commonly accompany a dislocation.

A casualty with a dislocation will present with the symptoms of a strain but will also have a deformity, sudden pain, swelling of a joint, and loss of power and movement.

• A first aider should NEVER attempt repositioning the joint – some GPs won’t even attempt this.
• A trained, experienced emergency specialist will use X-rays to characterise a dislocation and then use specific techniques to minimise it.
• These steps minimise the chance of causing further injury while reducing the dislocation.

Management

• Sit the injured person down and make them as comfortable as possible
• Support the injured limb in a comfortable position
• Ice packs can be applied to the area to help reduce swelling
• Seek medical assistance immediately. The longer the joint is out of place, the more significant the injury will be to the blood vessels and nerves.

Soft Tissue Injuries

Sprains and Strains

According to Sports Medicine Australia, these are the most common injuries in sports.

Sprains involve the overextension of a joint, which forces it to extend beyond its normal range of motion, usually with partial rupture of the ligaments. There may also be blood vessel, nerve, and tendon damage.

Strains involve over-stretching of the major muscles of the limb. Muscles are attached to bones by tendons, which tear if a muscle is forced to stretch excessively. A noticeable ‘pop’ may be heard if the tendon parts from the bone, and a discernible deformity to the muscle area may be visible.

This injury is usually less severe than a sprain but can still have complications if not managed correctly. Emergency services should be called in case of a soft tissue injury or fracture. Fortunately, first aid training in an Australian-registered training organisation such as CPR First Aid can teach you how to do this.

As you can see below, the symptoms are also quite similar.

Signs and Symptoms

Sprain

• Pain in the joint
• Swelling around the joint
• Bruising
• Loss of power and ability to bear weight

Strain

• Pain increases on movement
• Swelling in the muscle region
• Cramping
• Tenderness or discomfort when weight-bearing

Treatment: RICER Method

Aside from the popular DRSABCD, this is another acronym for first aid. What does RICER stand for? RICER stands for rest, ice, compression, elevation, and referral, which is helpful in the initial injury management of sprains and strains.

• Rest – Resting the injured part will encourage healing and prevent further injury.
• Ice—Use an ice pack for 20 minutes at a maximum, then remove it for 2 hours. Never apply ice directly to the skin (place it on top of a compression bandage); instead, wrap it in a towel or T-shirt.
• Compression—A crepe bandage should be applied moderately tight to help limit swelling and promote blood flow. Be careful not to use it too tightly on the affected area,  this can excessively cut off the blood supply.
• Elevation—This again helps to reduce swelling by making it more difficult for blood to travel to the part and helping the fluids drain away from the injured area. One example is lying down and resting a sprained ankle on a pillow.

• Referral—Refer the casualty for medical advice from a healthcare provider in Australia. A medical professional may prescribe pain relief medication and/or recommend physiotherapy treatment. A physiotherapist may then diagnose the condition and provide additional care.

In addition to the RICER treatment, some factors can hinder the healing process or cause further injury and damage. The following should be avoided for the first 48 – 72 hours after injury:

H.A.R.M.

HARM is an acronym for what you should not do after applying a cold pack and other RICER treatments.

• Heat has the opposite effect of cold, as it causes blood vessels to dilate, which increases swelling.
• Alcohol – This also causes dilation of blood vessels and hence increases the swelling of the injured area.
• Running or Exercise -Just like bones, ligaments, and tendons need time to heal and recover their strength, avoiding physical activities while recovering is ideal.
• Massage – Although this can benefit longstanding ailments, it should not be performed on the injured part in the first 48 hours following the injury.

Bruises

A bruise is a skin discolouration that results from the breakage of tiny blood vessels leaking close under the skin after an injury.

Blood from damaged blood vessels beneath the skin collects near the skin’s surface to appear as a black and blue mark.

Medically, a bruise is referred to as a contusion.

Treatment

• Rest – Resting the injured part will encourage healing and prevent further injury.
• Ice—Apply for 20 minutes at a maximum, then remove for 2 hours. Never apply ice directly to the skin; wrap it in a towel or T-shirt.

Conclusion

Proper first aid for skeletal and soft tissue injuries can prevent complications, reduce pain, and support recovery. Fractures require immobilisation and medical attention, while dislocations should never be repositioned without professional care. Sprains and strains benefit from the RICER method, and avoiding H.A.R.M. in the first 48–72 hours aids healing.

While first aid knowledge is vital, seeking medical help ensures proper diagnosis and treatment. Being prepared and informed can make a life-saving difference in an emergency.