Skeletal and Soft Tissue Injuries

Fractures

A fracture is a medical term used 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 a variety of mechanisms, such as a direct blow to a bone (motor vehicle accident or being punched in the face).

Types of Fractures

There are 3 main classifications of fractures that first aiders need to be concerned with and be aware of.

• 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 greatly increased chance of infection to both the wound and the bone.

A complicated fracture – refers to any fracture that has caused additional complications to organs. 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 there are secondary injuries that can be extremely severe.

Signs and Symptoms

There are however some signs and symptoms to look out for. Not all of these 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 when there is significant swelling, there is an underlying injury
• It can be very difficult 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
• In any event, if a fracture is suspected, then prompt, correct first aid can prevent further injury and assist in healing, as well as help reduce pain by immobilisation
  

Fracture Treatment

First aid of a suspected fracture involves 3 basic principles:

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

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

Tips for First Aid

• NEVER attempt to reposition a deformity
• If the limb appears to be numb, pale, or blue, this could signify damage to the blood supply. This is a medical emergency and you should call 000 immediately
• Although an obvious statement, 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

Dislocations

A dislocation involves the bones of a joint being displaced from its 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 and swelling of a joint and loss of power and movement.

• A first aider should NEVER attempt to re-position the joint – some GP’s won’t even attempt this
• A trained, experienced emergency specialist will utilise x-rays to characterise a dislocation, and then use specific techniques to minimise the dislocation
• These steps minimise the chance of causing further injury while reducing the dislocation

Management

• Sit the casualty 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

Sprains involve the over-extension of a joint, 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.

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

Signs and Symptoms

Treatment: R.I.C.E.R.

• Rest – Resting the injured part will encourage healing and prevent further injury.
• Ice – Apply for 20 minutes maximum at a time then remove for 2 hours. Never apply ice directly to the skin, (place on top of compression bandage) but rather wrap it in a towel or t-shirt.
• Compression – A crepe bandage should be applied moderately tight to help reduce the swelling. Be careful not to apply too tight, as this can cut off the blood supply excessively.
• Elevation – This again helps to reduce swelling by firstly making it more difficult for blood to travel to the part, and secondly helping fluids to drain away from the injured area.
• Referral – Refer the casualty to professional medical advice

In addition to the RICER treatment, there are also factors that can hinder healing or even cause further injury. The following should be avoided for the first 48 – 72 hours after injury:

H.A.R.M.

• Heat -This has the opposite effect to 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.
• Massage – Although this can be beneficial for 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 surface of the skin 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 maximum at a time then remove for 2 hours. Never apply ice directly to the skin, but rather wrap it in a towel or t-shirt.

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