ASSESSMENT You should check any patient who has suffered a significant accident or injury for fractures. A person with a fracture will exhibit some or all of the following signs and symptoms: • Cracking sound as the bone is injured
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• Deformity – a fractured limb may be bent or twisted or may be shorter than the opposite limb (comparing the injured side with the uninjured side may reveal a subtle change in shape)
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• ‘Grating’ noise or feeling when the fracture is moved
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• Signs and symptoms of shock
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• Inability to move the injured area
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• Instability of affected bones
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It can be difficult to tell whether or not a bone has been fractured. Always err on the side of caution. It is better to immobilise a sprain than to fail to immobilise a fracture.
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MANAGEMENT
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In an outdoor environment:
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• Support and immobilise the fractured bone. • Minimise the patient’s pain.
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• Ensure an adequate blood supply to any fractured limb by checking circulation (capillary refill), sensation and movement. • Protect an open fracture from infection.
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In an urban environment, you should not move the broken limb or apply a splint. Simply keep the patient still and contact emergency services.
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Immobilising fractures
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Fractures are immobilised to:
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• Prevent movement of bones • Reduce pain and swelling • Reduce the likelihood of further injury to internal organs, blood vessels and nerves • Prevent a closed fracture from becoming an open fracture
Assess circulation, sensation and movement in fingers or toes before you immobilise a fracture. Compromised circulation is a sign of a more serious injury. Damage to circulation and nerves can result in permanent damage or eventual loss of the limb. Arrange an urgent evacuation.
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• Pain and swelling – point tenderness over fracture site