Fractures are injuries that involve a break in the continuity of bone and is
defined according to its type and extent. Fractures occur when the bone is subjected to stress greater than it can withstand or absorb.
Fractures are caused by direct blows, crushing forces, sudden twisting motions and extreme muscle contraction. When the bone is broken, adjacent supporting structures are also damaged and adversely affected resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves and damaged blood vessels. Body organs may be injured by the force that caused the fracture or by fracture fragments.
Types of fractures
Complete fractures involve a break across the entire cross section of the bone and is frequently displaced (removed from its normal position). An incomplete fracture (eg. greenstick fracture) involves a break through only a part of the cross section of the bone. A comminuted fracture is one that produces several bone fragments. A close fracture (simple fracture) is one that doesn’t break the integrity of the skin. An open fracture (compound or complex fracture) is one in which the skin or mucous membrane wound extends to the fractured bone. Open fractures are graded according to the following criteria.
- Grade I is a clean wound less than 1 cm long.
- Grade II is a larger wound without extensive soft tissue damage.
- Grade III is highly contaminated, has extensive soft tissue damage and is the most severe form of open fracture.
Clinical manifestations of fractures
The clinical manifestations of various fractures include acute pain, loss of function, deformity, shortening of the injured extremity, crepitus, local swelling and discoloration. It is important to consider that not all clinical manifestations that were previously mentioned are present in every fracture. For example, many are not visibly present with linear or fissure fracture or with impacted fractures. The diagnosis of a fracture is based on the patient’s symptoms, the physical signs and the x-ray findings which is the final diagnostic tool that can verify the existence of a fracture. Usually, the patient reports having sustained an injury to that area where there is a suspected fracture.
General emergency management for fractures
Immediately after injury, whenever a fracture is suspected, it is important to immobilize the injured body part or extremity before the individual is to be moved and transferred to a health care facility. If an injured patient must be removed from a vehicle before splints can be applied, the extremity must be supported starting at the distal to the proximal end of the fracture site to prevent rotation as well as angular motion. Adequate splinting is very important to properly stabilize the proximal or distal joint involved. Joints nearest and farthest the fracture site must be immobilized to prevent movement of fracture fragments that can cause additional pain, soft tissue damage and bleeding.
A temporary but well padded splint coupled with a firmly bandaged over clothing is also useful in serving to immobilize the fracture. Immobilization of the long bones of the lower extremities may be better accomplished by firm and proper bandaging of the two legs to serve as a splint to the injured extremity. In an upper extremity fracture, the arm may be bandaged to the chest, or an injured forearm may be immobilized using a sling . The neurovascular status farthest of the injury should be frequently assessed before and after splinting in order to determine the adequacy of peripheral tissue perfusion and nerve function following the injuries and fractures to the extremities.