FRACTURE

Fracture is a complete or incomplete disruption (break) in the continuity of the

bone structure. When the bone is broken, adjacent structures are affected resulting
in soft tissue oedema, hemorrhage into muscles and joints, joint dislocations,
ruptured tendons, severed nerves and damaged blood vessels.

Fracture is a traumatic injury interrupting bone continuity.

CLASSIFICATION/TYPES OF FRACTURE

1. Closed, simple, uncomplicated fracture: the fracture do not cause a break in

the skin, or communicate with the outside area.
2. Open ,compound, complicated fracture: involve trauma to surrounding
tissues and break in the skin. This fracture is one that extends through the
skin and mucous membrane. It is complicated because some internal organs
like major blood vessels, spinal cord, lung, liver may be injured.
3. Incomplete fracture: are partial cross-sectional breaks with incomplete bone
disruption.
4. Complete fracture: are complete cross-sectional breaks severing the
periosteum
5. Communicated fracture it is fracture with more than two fragments. It
crushed or broken in several places/ fragments.
6. Oblique fracture: this is fracture in which the line of the fracture extends in
an oblique direction. The fracture line is 45˚ angle to the long axis.
7. Impacted fracture; fracture fragment are pushed into each other. It happen in
a fracture of the shaft of the femur when the head of the femur pushed into
the acetabulum.
8. Pathological fracture: This occurs when the bone is weakened by a disease
e.g tumor, osteoporosis, bone cyst
9. Greenstick fracture: A fracture in which one side of a bone is broken and
the other side is bent. Instead of breaking it bends like a green twig. This is
common in children below 12 years
10.Transverse fracture: fracture line is perpendicular to long axis bone, in
which line of the fracture extends across the bone shaft at a right angle to the
longitudinal axis. The fracture is straight across the bone.
11.Depressed fracture: it is a fracture in which fracture segment are indriven
12.Compression: in this, the fracture bone is compressed by one another bone
(seen in vertebral fracture).
13.Spiral fracture: it a fracture twisting around the shaft of the bone.
CAUSES
Fractures may be caused by the following:
1. Direct blows: being hit directly by a great force could cause fractures in
the bones.
2. Crushing forces: forces that come into contact with the bones and crush
them
3. Sudden twisting motions
4. Extreme muscle contractions: when the muscles have reached their limit
in contraction, it could lead to serious fracture.
5. Pathological fractures result from a weakness in bone issue, which may
be caused by neoplasm or a malignant growth.
A fracture is diagnosed by:
1. Pain is continuous and increase in severity until the bone fragment are
immobilized. There is muscle spasm as a result of involuntary reflex
action of muscle, direct tissue trauma, increased pressure on sensory
nerve and movement of the fracture part.
2. Loss of function: due to disruption of bone, preventing functional use.
3. Tenderness on palpation at the site of fracture.
4. Swelling at the site of fracture.
5. Deformity : this results from loss of bone continuity.
6. Crepitus : when the extremity is gently palpated, a crumbling
sensation called crepitus can be felt.
7. Abnormal mobility at the site of fracture
8. Localized oedema and Ecchymosis occur after a fracture as a result of
trauma and bleeding into the tissues.
FIRST AIDS MEASURES FOR ANY FRACTURE
1. Reassure the patient
2. Control bleeding
3. Cover any wound with sterile dressing
4. Immobilized the injured part immediately, so that no movement is
possible.
 5. Do not apply bandage over the area of fracture
6. Do not give the patient anything orally.
7. Transport the patient to the hospital

Fracture of the skull

In most cases, the patient becomes unconscious. There may be vomiting,
slow pulse rate, paralysis of limbs, disturbance of eye movements, distortion
of face and speech disorders. The signs of fracture of the base of skull
include flow of blood, cerebrospinal fluid may come from nose, ear, mouth
and bleeding around eyes are seen.
First aid measure
 Lie patient in supine position.
 Elevate the head with a pillow under it.
 Turn the head to one side.
 If there is bleeding from an ear, turn the head to that side.
 If there is wound on the scalp trim hair around it and cover the wound
with sterile dressing.
Fracture of face
 Cover the wound with clean cloth
 Support the broken lower jaw with a bandage, looped under the jaw, and
over the top of the head.
 Tilt the head forward over a bowl as blood and fluid may be falling to
the back of the throat.
 Keep the airway clean
 Put the patient in supine position with head turned to one side if he is
unconscious
 Transport to the hospital

Spinal fracture
Paralysis is a complication of spinal fracture
 Check whether the patient can move
 Check the loss of sensation in the lower limbs
 Make the patient lie still on a flat surface
 Get a doctor immediately
  If a doctor is not available. Place a pad between the patient’s ankle
and bandage the feet together with figure of eight bandage. Place the
pad between knees and thighs, tie the legs together using broad
bandage. Transfer the patient to a hospital. While moving the patient,
take help of four persons, lift and move the patient as one piece in a
stretcher

Fracture of Tibia and Fibula

Signs and symptoms
 Pains
 Swelling
 Deformity
First aids
 The broken limb should be tied to the sound limb, after proper padding.
 Apply bandage at the upper part of the thigh, on the knee, above the
fracture and below the fracture.
 Transport the patient to hospital in a stretcher.
SPRAIN AND DISLOCATIONS OF JOINTS
SPRAIN
A sprain is the tearing of ligaments of a joint or tissues around the joint
Causes
Sudden twist
Signs and symptoms
Bruising at the site
Pain and swelling
Severe pain on movement.
First aids
Place the limb in a comfortable position
Do not move the limb unnecessary
Apply a firm bandage to the joint
Keep the bandage wet with cold water
DISCLOCATION
In dislocation, there is tearing of tissue around the joints and dislocation of bones
Sign and symptoms
1. Severe pain around the joint
2. Inability to move the joint
3. Swelling
4. Deformity.
First aids
1. Support the joint
2. If the dislocation occurs in arm, put it in a sling
3. In case of leg, immobilize the limb
4. Transport the casualty to the hospital.
 POISONING

A poison is any substance which when taken into the body or applied externally
injuries or destroys the tissues.

There are usually three causes of poisoning

1. Accident
 Eating contaminated food, poison berries
 Drinking contaminated water or drinking poisonous liquid from wrongly
labeled bottles
Accidentally taking an overdose of drugs or sedatives.
2. Suicide
Attempted suicide should be suspected if an apparently healthy person is
found obviously ill and still conscious but making no effort to obtain help.
3. Murder
Murder or attempted murder may be carried out by the introduction of
poison. The poison may be administered in a large dose or in repeated small
doses.
Classification of poison
Poisons are usually classified under three headings
1. Irritant poisons : These act on the alimentary tract causing irritation and
inflammation
Sources of irritant poisons
 Contaminated food e.g tinned food, or fish and meat paste e.g sauges
 Poisonous berries or fungi
 Chemical substances e.g arsenic, mercury, phosphorus, iodine and
lead.
 When someone has taken a poison the label of the container and the
container itself or the details on the label should be taken to the
hospital with the patient.

2. Narcotic poisons : This act on the nervous system

Effect of narcotic poisons on the body
 They act as hypnotics ; Hypnotics induce sleep and unconsciousness
e.g opium, morphine, cocaine, heroin.
  They can act as deliriants. This initially produce excitement and
delirium but can lead to unconsciousness e.g atropine
 They act as convulsants: convulsants produce twitching of the limbs
and eventually unconsciousness
3. Corrosive poisons
This type of poisons can burn the parts of the body when comes in
contact with the body. e.g acid or alkaline.
Acid corrosive e.g Sulphuric acid, hydrochloric acid (HCL) acetic acid,
nitric acid.
Alkaline corrosives e.g caustic soda, caustic potash and ammonia.

Aims of first aid treatment in poisoning.

 To remove or counteract the effect of the poison
 To send for medical aid
 To arrange transport to the hospital as quickly as possible.
 To identify the poison, all containers of medicine bottle , empty glasses
or remnants of food should be kept for inspection.
 Any vomit. Urine, or faeces should be kept for medical inspection
 If death occurs the police must be informed and nothing around the body
should be touched or removed until police arrival.
If the casualty is unconscious
 Place him in the recovery position or prone position with the head turned
to one side and not resting on a pillow. This will help to prevent vomited
matter from entering the trachea and keep the tongue clear of the airway.
It also makes it easier to apply artificial respirations at once should this
be necessary.
 Start artificial respiration instantly if the breathing is unduly slow.
Certain substances capable of counteract the effect of poison
1. Emetics
An emetics is a substance which is capable of producing vomiting,
this removing the poison from the stomach. The emetics should be
given as soon as possible after ingesting poison so that the person can
vomit it before it is absorbed into the blood stream.
Most commonly used emetics and easy to prepare
 a. Salt and water—2 tablespoonfuls of salt dissolved in a tumblerful
of tepid water, followed by large amount of tepid water.
b. Several tumblerfuls of tepid water: This may be followed by
irritation of the throat with a finger to speed up vomiting.
2. Antidotes: An antidote is a substance which neutralizes or counteracts
the effect of a poison. Some antidotes act by preventing the absorption
of the drug into the blood stream. E.g if the poison is an acid an
alkaline drink can be given. This can be prepared by adding one level
teaspoonful of bicarbonate of soda to a cup of water. If the poison is
an alkaline an acid drink can be given. This can be prepared by adding
3 tablespoonful of vinegar to a cup of water.
3. Aperients
These are given after vomiting have been induced to remove any
poison which may have passed into the intestine e.g castor oil or
Epsom salt.
If castor oil is used, a suitable dose is two tablespoonful for an adult
or two teaspoonful for a child. One dessert spoonful of Epsom salts is
added to a glass of water.
4. Demulcents : is a substance which soothes irritated mucous
membranes. This is given after the person has vomited. E.g milk this
is most palatable, salad dressing or mayonnaise, olive oil, liquid
paraffin, pap.

Treatment for special poisoning

Irritant poisoning

Signs and symptoms

 Nausea
 Vomiting
 Acute abdominal pain
 Diarrhea
 Fainting attack
 Shock
 Unconsciousness
Treatment

 Give emetic
 After patient has vomited, give a demulcent
 About 10 minutes after vomiting has ceased, give an aperient
 Treat for shock if present
 Send for medical aid or arrange to transport the patient to the hospital
 If the poison is known, an antidote can be given.

Narcotic poisoning
Signs and symptoms
 Drowsiness
 Slow respiration
 Feeble pulse
 Pin-point pupils
 Coma and subsequent death
Treatment
 If the person is still conscious although drowsy, try to keep him awake by
making him walk about.
 Give him or her emetic and repeat the emetic at frequent intervals
 After vomiting give a stimulant
 An aperient should also be given
 If patient is unconscious, transport to the hospital.
 If breathing ceases, start artificial respiration.
Deliriant poisoning
Signs and symptoms
 Dryness of the mouth and throat
 Thirst
 Dilated pupils
 Unsteadiness
 Delirium
 Coma
Treatment
 Give an emetic
 After vomiting give the patient strong tea or strong black coffee.
 Send for medical aid or arrange for transportation to the hospital
 If breathing ceases, start artificial respiration.

Convulsant poisoning
Signs and symptoms
 Anxiousness
 Feeling of suffocation
 Twitching of muscles, this may develop into epileptic form of
convulsion.
Treatment
 If possible give an emetic
 After vomiting give strong tea
 Send for medical aid
 If breathing ceases, apply artificial respiration.

Corrosive poisoning
Signs and symptoms
 Severe burns round the mouth and lips
 Difficulty in speaking and breathing
 Severe pain in the mouth throat chest and abdomen
 There may be nausea and vomiting
 Severe shock
Treatment
 Do not give emetic as the mucus membranes will be burnt again when
the patient vomits
 Give an antidote if it is not known whether the corrosive is an acid or an
alkalis try to dilute the poison by giving copious drinks of water.
 Give demulcent to soothe the damage mucous membranes
 Treat for shock
 Sent for medical aid

Carbolic and Lysol poisoning

 The action of carbolic and Lysol is slightly different from that of other
corrosives. They harden as well as burn the mucous membranes.
Signs and symptoms
 There will be a burning sensation in the mouth, chest, throat and
abdomen.
 There will be severe pain in these parts but the pain will soon reduced
due to the anaesthetic effect of carbolic and lysol’
 There may or may not be vomiting
 The breathe smells odour of the poison
 The gums and cheek appear whitish in colour
 Severe shock present
 Treatment
 Give emetics
 Give liquid paraffin as as antidote and demulcent or give one
tablespoonful of Epsom salt dissolved in a glass of milk
 Treat for shock
 Send for medical aid or arrange for transportation to the hospital.