Breaks

A broken or cracked bone is known as a fracture. Fractures can affect any bone in the body, and bones can fracture in a number of different ways.

Fractures

Are broken bones protruding through the skin or is there a wound at the expected fracture site?

Yes: This is an “open fracture” and carries a risk of becoming infected unless medical attention is sought immediately, either by calling an ambulance, or by going to A&E. There is often bleeding, and the patient may suffer shock.

What to do before you travel: Wearing sterile gloves if you have them, work from the noninjured side of the body and cover the wound with a sterile pad or dressing. You may need to apply several pads to protect the bone fully. Apply enough pressure to slow bleeding but be careful not to press directly on to the protruding bone. Place a bandage firmly around the dressing and secure it with a safety pin. If necessary, immobilise limbs as described for the closed fractures below by bandaging them to a noninjured body part.

Is there significant difficulty in moving a limb (normally coupled with deformity, swelling or bruising) at the site of injury?

No: It could be a sprain or dislocation.

Yes: It is likely to be a “closed” fracture, meaning the broken bones have not broken the skin. An X-ray or scan will confirm whether the bone is broken. Both need immediate hospital attention.

What to do first, or on the way: Tell the patient to stay as still as possible, preferably lying down. Either hold the injured part or bandage it to a noninjured body part, always tying the bandage on the unaffected side of the body. For specific fractures:

Collarbone: Fractures between the shoulder blade and top of the breastbone are common in sports people. The patient should hold the injured arm across their chest, supported at the elbow with the other hand. Put on a sling.

Upper arm: This is common in the elderly after a fall. Tell the patient to hold the injured arm across his/her chest, supported at the elbow with the other hand. Place padding beneath the injured arm and apply a sling.

Leg/ankle: Ask the patient to lie down and support the leg at the ankle and knee joint. Put padding (blankets or a coat) around the injured leg while you wait for an ambulance, or on the way to the hospital. If the ambulance is likely to take some time, make a splint.

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