4x4 Clubhouse

________Fractures________

The Skeleton

The body is built on a framework of bones called the skeleton.

This skeleton :-

• Supports the body

• Give it basic shape

• Provides protection for the internal organs of the body. for example: The skull surrounds and protects the brain, and the rib cage protects the lungs, heart and other vital organs.

• the bones are also important for movement.

Fractures

A fracture is a broken or cracked bone.

Causes of Fractures:

• Direct force, when the bone breaks at the spot where the force is append, e.g. from a kick or blow.

• Indirect force, when the bone breaks at some distance from the spot where the force is applied, e.g. fracture of the collar, bone may result from a fall on the out stretched hand.

Type of fracture:-

1. Closed fracture, where the skin surface is not broken.

2. Open fracture, when there is a wound leading down to the fracture.

3. Complicated fracture, closed or open fracture are said to be ( complicated ) when their is associated injury. For example if an important structure, blood vessel, nerve or organ is damaged by the broken bone end.

General symptoms and signs:-

• Pain

• Tenderness

• Swelling

• Loss of control

• Deformity

• Crepitation

• Shock

• Unnatural movement

General rules for treatment :-

1. Asphyxia, bleeding and severe wounds must be dealt with before dealing with any fracture.

2. Treat the fracture on the site of the incident, unless life is endangered, (the casualty's, or your own).

3. Immobilize the injured part at once.

4. Raise the injured part after immobilization, if possible.

5. If splint are required, they should be,

   • Sufficiently rigid.

   • Long enough to immobilize the joint above and below the fracture.
     * In emergencies, a splint may be improvised from a walking stick, umbrella, broom handle, piece of wood card board or firmly folded newspaper or magazine.

6. All casualties who have fractures or suspected fractures must be sent to hospital for attention.

7. Transport of the casualty should be as gently as possible.

 Skull Fractures

• A fracture of the skull ( Cranium ) is usually caused by a direct blow to the skull or a fall on the head.

• A fracture of the base of the skull is usually caused by an indirect force such as a severe fall when the casualty lands on his feet, or a blow to the jaw.

Symptoms And Signs:-

• Obvious sing of head injury.

• Blood and or clear watery ( Cerebrospinal Fluid my issue from the ear or the nose.)

• Their may be a blood - shot and later a black eye.

• Pupils may be unequally dilated.

• Loss of consciousness.

Treatment

AIM :- Arrange urgent removal to hospital.

1. If the casualty is conscious, place in a half sitting position with the head and shoulders supported.

2. If any discharge issues from the ear, incline the head towards the injured side, cover the ear with a sterile dressing or similar pad and secure very lightly with bandage. Do not plug the ear.

3. If the casualty is unconscious but breathing normally, place in the recover position with the head lying on the affected side.

4. Check the breathing rate, pulse and levels of responsiveness at 10 minute intervals.

5. If breathing and heartbeat stop, begin resuscitation immediately.

6. Remove to hospitals.

Jaw and facial Fractures

Fractures and wounds to the jaw and face may be complicated by further damage to the brain, skull or bones in the neck. The serious risks:-

• The airway may be obstructed.

• Possibility of severe bleeding.

Injuries to the face may include:-

• Nasal fracture.

• Cheek - bone and upper jaw fracture.

• Lower jaw fracture.

Nasal Fracture

• Besides bleeding, the main problem associated with a nasal fracture is blockage of the airway so every effort must be made to ensure that the casualty has an open airway.

• A cold compress may provide some relief.

• Usually there is no pressing need to immobilize a nasal fracture.

• Treat any nose bleeding and remove the casualty to hospital.

Lower Jaw Fracture:

This is usually the result of direct force for example a heavy blow to the jaw.

Symptoms And Signs:-

• Pain, increased by jaw movement

• Difficulty in speaking

• Wound inside the casualty's mouth

• Swelling and tenderness

• Irregularity of the teeth may be seen

Treatment:-

1. Maintain the casualty's breathing by ensuring a clear airway.

2. Control any bleeding and treat any wound.

3. If conscious and not seriously injured, sit the casualty up with the head well forward to allow any secretion to drain away.

4. Support the jaw with a soft pad. Ask the casualty to hold it in place or, if necessary, tie a narrow bandage or other bandage around the casualty's head; tie the knot on the top of the head.

5. If vomiting occurs, quickly release the bandage and support the casualty's jaw and head. Gently clean out the casualty's mouth completely before replacing the bandage.

6. If the casualty is severely injured with downward displacement of the jaw or the casualty is, or becomes, unconscious and is breathing normally, place a soft pad under the casualty's head to raise it and keep the weight off the jaw.

7. If breathing and heartbeat stop, begin resuscitation immediately. You may need to use mouth to mouth ventilation.

8. Remove to hospital immediately maintaining the treatment position.

Cheek Bone Upper Jaw Fracture

Although there may not be any obvious signs of soft tissue wounds around the injury, there will probably be:-

• Blood issuing from the nose.

• Sever swelling of the face and bruising a round the eyes.

• The wound may affect breathing.

Treatment :-

1. Place a cold compress over the injured area to lessen swelling ,bleeding and pain. Make sure you do not interfere with breathing and that bleeding from any mouth wound dose not obstruct airway.

2. Treat any mouth wound

3. Remove to hospital.

Rib Fractures

Rib fractures usually result from direct force, such as a blow to the chest.

Symptoms And Signs

• General symptoms and signs of fractures.

• Sharp pain increased or coughing.

• There may be open wound causing a " sucking wound ".

Treatment :-

For a complicated fracture:-

1. Immediately treat any " sucking "

2. Lay the casualty down in a half-sitting position with the head and shoulders supported and the body inclined towards the injured side. supported the casualty by placing a folded blanket lengthwise along the back.

3. Support the limb on the injured side in an elevation sling.

4. If the casualty is unconscious or breathing becomes difficult and, or noisy, place in the covory position with the uninjured side uppermost.

5. Remove to hospital. Transport as stretcher case maintaining the treatment position.

Collar - bone Fractures:

• A collar - bone fracture is commonly caused by indirect force resulting from a fall on an outstretched hand or the point of the shoulder.

• Collar - bone fracture due to direct are rare.
  
  

Symptoms and Signs:

• General symptoms and signs of fracture.

• Casualty may support the arm on the injured side at the elbow and my keep the head inclined towards the injured side to relieve pain.

Treatment

1. Gently place the limb on the injured side across the casualty's chest with the finger-tips almost resting on the opposite shoulder.

2. Place padding between the limb and chest on the affected side.

3. Support the limb and padding in an elevation sling.

4. For additional support, secure the limb to the chest by applying aboard bandage over the sling, tie the knot in front on the uninjured side.

5. remove to hospital.

Arm Fractures

Fractures can occur anywhere along the length of the upper-arm bone or the two forearm bones, and may involve the elbow an upper arm bone.

Treatment

1. Place a pad in the person's armpit.

2. Use a padded splint.

3. Support the lower arm with a narrow around the neck and wrist.

4. Use a wide bandage to bind the upper arm to the chest.

Elbow Fractures

( I ) If the elbow can be bent :

Treatment

1. Gently support the injured limb across the casualty's chest. Place soft padding between the injured limb and the chest. If wrist or forearm is injured, place in an extra flod of soft padding.

2. Support limb and padding in an arm sling.

3. For additional support, secure the limb to the chest with broad bandage applied over the sling tie the knot in front on the uninjured side.

4. Remove to hospital.

Elbow Fractures

( II ) If the elbow cannot be bent,

Treatment

1. Lay the casualty down and place the injured limb by the side of the trunk. Do not attempt to bend the elbow forcibly. Ask the casualty to support it in that position with the other hand if possible. Place soft padding brown Secure the injured limb to the body by three broad bandages. Around the wrist and thighs, around the upper arm and trunk, around the forearm and trunk.

2. Remove casualty to hospital. Transport as a stretcher case maintaining the treatment position.

Fracture To The Forearm 

Symptoms and signs

• General symptom and sings of fracture.

Treatment

1. Place large triangular bandage.

2. Place a padded splint around the injured arm extending from the elbow to the middle of the fingers.

3. Place the arm gently across the person's chest.

4. Check for pulse.

Hand and Finger Fractures

Fractures of the hand are usually due to direct force. They are sometimes the result of crush injuries and may involve severe bleeding.

Symptoms and Signs

• General symptoms and sings of fracture.

• Casualty is unable to use fingers.

• Extensive swelling and bruising at the site of injury.

Treatment

1. Control bleeding and treat any wounds.

2. Protect the injured hand by placing in a fold of soft padding.

3. Gently support the affected limb in an elevation sling.

4. For additional support, secure the limb to the chest by applying a board bandage over the sling tie the knot in front on the uninjured side.

5. Remove to hospital.

Pelvic Fractures

Pelvis injuries can be complicated by injury to the bladder and urinary passages.

Symptoms & sings

• General symptoms and signs of fractures.

• Casualty may express a great desire to pass water.

• If the casualty dose pass water it may be blood stained.

• Symptoms and sings of shock.

Treatment :

1. Tell the casualty not to pass water.

2. Apply two broad bandages round the pelvis.

3. If he wishes to bend knees slightly, they should be supported on a folded blanket.

Hip and Thigh - bone Fractures

All incidents where the thigh - bone is fractured should be regarded as serious because, in most cases, a large volume of blood is lost.

Symptoms and signs

• General symptoms and signs of fractures.

• The limb may be shortened by contraction of muscles around fractured bone.

• Symptoms and sings of shock.

Treatment

1. If the thigh-bone is fractured place an additional longer splint and padding along the outside of the fractured limb extending from armpit to foot.

2. apply additional padding on the outside of the limb where the splint touches bony areas, at the ankles and hips for example, and in any hollows.

3. Secure the top end of the long splint with two broad bandages one around the chest just below the armpits and one around the pelvis in line with the hip joints. Then bandage the lower legs and splint as for a rough journey.

4. Tie knots over the splint.

Knee - Cap Fractures
It may be fractured by a direct blow or as the result of muscular action, such as a mis kick.

Symptoms and sings

• General symptoms and signs of fractures.

• Loss of movement of knee joint.

Treatment

1. Lay the casualty on the back with the head and shoulders raise arid supported with rolled blankets or coats.

2. Gently raise and support the injured limb on a splint extending from the buttocks to beyond the heel which is extra padding under the knee, but only sufficient to fill the hollow. Place adequate padding under the heel in order to raise it off the splint.

3. Apply a figure of eight bandage around the ankle, foot and splint tie the knots against the side of the splint. apply broad bandages around the thigh and splint and around the lower leg and splint. Tie off on the outer side of the fractured limb.

4. Remove to hospital, transport as a stretcher case maintaining the treatment position.

Lower Leg Fractures

Either or both of the bones of the lower leg, (tibia) and ( fibula) may be broken.

Symptoms and sings

• General symptoms and sings of fracture

• Angulation and rotation will be seen only if both bones are broken.

• Possible symptoms and sings of shock.

Treatment for lower limb fracture

1. Lay the casualty down and carefully steady and support the limb by hand.

2. Tie a figure-of-eight bandage around the feet and ankles and a board bandage around the knees, tie all the knots on the uninjured side.

3. If splints are available ( for fractured leg ) support the injured limb and place a splint with adequate padding between the legs extending from crotch to foot. Apply padding and bandage as for a rough journey.

Foot Fractures

Fractures of the foot often result from direct injuries such as crushed by heavy objects.

However injury can also result from twisting falls or jumps.

Symptoms and sings

• General symptoms and sings of fracture

Treatment

1. Lay the casualty down.

2. Raise and support the injured foot.

3. Gently remove the shoe and sock.

4. Control bleeding and dress any wounds.

5. Place a splint with adequate padding on the sole of the foot.

6. Secure with a finger of eight bandage. Place center of broad bandage over splint on sole of foot and cross the ends over the instep.

7. Take ends around behind ankle, cross them again and bring them around to the front.

8. Cross them once more over the instep and take them under the foot, tie off over splint.

9. keep the foot raised and supported.

10. Remove to hospital, transport as a stretcher case, maintaining the treatment position.

Spine Fractures

A fractured spine is always classed as a serious injury, necessitating the greatest care in handling because it may be complicated by damage to the spinal cord.

Symptoms and sings

• Casualty may complain of severe pain in the back and may feel " cut in half ".

• Casualty may have no control over limbs, ask the casualty to move wrists, ankles, fingers and toes.

• Possible loss of sensation. Test these by gently touching limbs without the casualty's knowledge and ask if anything can be felt.

Treatment

1. Advise the casualty not to move.

2. Support the neck by collar.

3. Place soft padding between the lower limbs.

4. Tie a figure-of-eight bandage around the ankles and feet and broad bandages around the thighs and knees.

5. Remove to hospital transport the casualty on a rigid stretcher.