FRACTURES. A fracture is any break in a bone, including chips, cracks, splintering, and complete breaks.

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1 FRACTURES Definition: A fracture is any break in a bone, including chips, cracks, splintering, and complete breaks. Two Basic Types Of Fracture: 1. Closed Fracture (Simple fracture): Occurs when a bone is broken but there is no penetration extending from the fracture through the skin. 2. Open Fracture: (Compound fracture) Is a fracture in which there is a wound over the fracture site, with or without bone protruding through it. This type of fracture is more serious than closed fractures because the risks of contamination and infection are greater. Fractures are further classified according to their appearance on x-ray: Types of fracture A. Green stick fracture Usually occurs in children whose bones are still pliable (like green sticks) A break occurs straight across part of the width of the bone, perpendicular to the long axis B. Transverse Fracture Cuts across the bone at right angles to its long axis often caused by direct injury C. Oblique Fracture The fracture line crosses the bone at an oblique angle D. Comminuted Fracture: The bone is fragmented into more than two pieces E. Impacted Fracture: The broken ends of the bone are jammed together F. Spiral Fracture: Usually results from twisting injuries The fracture line has the appearance of a spring 1

2 Causes Of Fractures: 1. Direct Force The bone breaks at the spot of application of the force e.g., direct hit over a bone, bullet injury. 2. Indirect Force The bone breaks away from the application of force somewhere else, e.g. after falling on outside stretched hands. 3. Force of Powerful Muscle Actions For example, violent cough may cause rib fracture 4. Aging and bone disease Can increase the risk of fractures (pathologic fractures), with bones breaking even minor accidents 5. Twisting Forces Such injuries are often seen in football and skiing accidents where a person's foot is caught and twisted with enough forces to fracture a leg bone. Signs And Symptoms Of Fractures: 1. The primary symptom of fracture is PAIN. Pain is often severe and constant and is felt at or near the site of fracture The patient may report that he heard something snap or felt the bone break. 2. Swelling And Discoloration These begin shortly after injury Discoloration my start as reddening of the skin 3. Tenderness Or Discomfort which may lead to severe restriction or use of the area affected 4. Bone may BREAK through the skin 5. DEFORMITY General principles for treatment of fractures: 1. Establish and maintain an open airway 2. Control hemorrhage 2

3 3. Close sucking chest wound 4. Begin fluid resuscitation 5. After dealing with life-threatening conditions, identify and immobilize all fractures. Immobilization is accomplished by splinting. Splints A splint is a device used to immobilize a fracture. Types: A) Improvised: Rolled newspaper Wood Strong cartons Cane Ironing board Any object that can provide stability B) Commercially Available Splints: Rigid splints (padded board, aluminum splint) Inflatable splints Traction splints General Principles Of Splinting: 1. The clothing is best removed from the area of any suspected fracture or dislocation 2. Note and record motion and sensation status distal to the site of injury 3. The splint should immobilize the joints above and the joints below the fracture. 4. During splint application, minimal movement of the limb should be allowed. 5. Severely deformed limb should be straightened with constant gentle manual traction so that the limb can be incorporated in to the splint. 6. If gentle traction increases the patient's pain significantly or if resistance to the limb alignment is encountered, the limb must be splinted in the position of deformity. 7. Cover all wounds with dry sterile dressing before applying a splint. 8. Pad the splint to prevent local pressure. 9. Do not move or transport patients before splinting extremely injuries. 10. when in doubt, splint. 3

4 Hemorrhage Hemorrhage means extravasation of blood. Classification: - External - Internal External hemorrhage - Types: o Arterial bleeding: loss of blood from arteries o Blood loss is rapid and profuse o The color of blood is bright red o Blood spurts as the heart beats o Venous Bleeding: loss of blood from veins o Blood loss is a steady flow o The color of blood is dark o Capillary Bleeding: loss of blood from capillary bed o Blood flow is slow o The color of blood is red but less bright - Methods used to control external bleeding o Direct pressure: is a most effective method o Apply direct and firm pressure to the wound o Elevation of the limb o Pressure point on the artery o Splinting: used in sever laceration or cut extends over the length of the extremity. o Blood pressure cuff: the cuff is placed above the wound, and can be left for up to 30min. o Mast Garments: pneumatic counter-pressure devices for serious abdominal bleeding o Applying Tourniquet: is a last resort used only when other methods to control bleeding have failed. 4

5 Internal hemorrhage - Causes of internal hemorrhage: Deep chest or abdominal wound Any cut into muscle or fracturing of bone Bleeding ulcers - Detecting internal bleeding: assume internal bleeding whenever the following are present o Wound that have penetrated the skull Blood in the ear Vomiting or coughing up blood Wound that have penetrated the chest or abdomen Large areas of bruised abdomen Abdominal tenderness, rigidity, or spasm Blood in urine Rectal bleeding Bone fractures mainly the long bone of the arm or thigh. Epistaxis Epistaxis (nose bleeding): means hemorrhage from the nose, due to mainly spontaneous rupture of minute vessels. - Local causes: o Trauma Blow on the nose Nose picking Foreign body o Infection: acute / chronic rhinitis o Violent sneezing o Eroding neoplasm in the nasal cavity, nasopharynx, or sinuses. - General and systemic causes: 5

6 o Acute infectious fever o High altitudes o Hypertension o Blood diseases First aid treatment - Apply pressure by pinching the nostrils - Keep the patient in a setting position - Apply ice over the nose - Keep the patient quite Hospital emergency care: - Simple packing of the nose - Use of adrenaline nasal pack - Use of diathermy - In hypertension cases: sedation and reduce blood pressure - Check for blood coagulative disorders. 6