Mechanism of Injury
The force that injures a bone or joint may also cause injuries to the surrounding soft tissues (such as nerves and arteries), or even to body areas distant from bone injury site.

Direct Force
The fracture from direct force

or a direct blow, occurs at the point of impact

Ex. A victim in an automobile accident who is not wearing a seatbelt might be thrust forward,

Indirect force affects one end of a limb, causing an injury to the limb some distance away from the point of impact. In this case, the previous scenario might lead to a hip fracture or dislocation.

Indirect Force

Ex. Woman thrown from a

horse may land on two outstretched hands. One arm sustains a fractures wrist, and the clavicle (collarbone) at the end of the other arm is fractured.

Twisting Force
When a bone is fractured by twisting force, one

part of the bone remains stationary while the rest of the bone twists.

Ex. A child running across a field may

step into a hole. The foot is rammed snugly into the hole and stays stationary while the rest of the lower leg twist and is fractured. Bone and joint injuries from twisting force commonly occur in football or skiing accidents.

Signs and Symptoms:

Children’s bones are much more flexible than those of adults, and fractures are often incomplete (gree ns tick fra ctures )

It is difficult to tell whether a bone is broken, so

when in doubt, always treat the injury as a fracture. Fracture should be treated in priority as follows:

Spinal Fractures Fractures of the head and ribcage Pelvic Fractures Fractures of the lower limbs Fractures of the upper limbs

If there was enough force to damage the pelvis or to cause severe head damage to the pelvis or to cause severe head or facial injuries, assume there are also injuries to the spine.

The most important first aid care is mobilization of any suspected fracture or extensive soft-tissue injury. You should immobilize before you apply ice or elevate the injured part; doing so: § Minimizes damage to soft tissue, muscle, or bone sheathing that may become wedged between fracture fragments. § Prevents a closed fracture from becoming an open one. § Prevents more damage to surrounding nerves, blood vessels, and other tissues from the broken bone ends.

vMinimizes bleeding and swelling vDiminishes pain, which helps control shock vPrevents restriction of blood flow by bone ends compressing blood vessels

Any fracture to the spine is always a first priority for treatment. Treat the fractures as follows:
Support the injured part; gently remove

clothing and jewelry around the injury site without moving the injured area.

Cover any open wounds with sterile dressings

to control bleeding and prevent infection. Gently wipe away dirt and debris, and irrigate the exposed bone end with clean water.

Assess blood flow and nerve function; this step is

essential, since the most serious complication of fracture is reduced blood flow and subsequent tissue death. Check the distal pulse of the suspected fracture site- the wrist for an arm fracture, the ankle for leg fracture. Lack of a pulse indicates a direct medical emergency. Gently manipulate the limb once in an attempt to restore circulation. Also check the capillary refill by pressing on the nailbeds. As you let go, the nails will turn from white to pink, if normal. To assess nerve function, gently squeeze the victim’s fingers or toes; if the victim can’t feel squeeze, there may be nerve damage.

If there is severe deformity or

angulation, apply minimal traction- a firm, steady pull to bring the limb into more normal alignment- except for crushing injuries; immobilize the joints above and below the fracture. When applying traction, grasp an arm with one hand on either of the injury, and pull injury and steadily downward. Do not attempt to push bone ends back underneath the skin, and avoid excessive pressure on the

General rule:

Never st raig ht en a wr ist , elb ow, kn ee or sh ou lder . Except for the wrist and shoulder, make one attempt to straighten closed, angulated fractures if no dist al pulse is foun d.  If pain, resistance, or crepitus increases, stop. Wrap from the distal end of the splint to the proximal end; splint firmly enough to immobilize but not tightly enough to stop blood circulation.

Check the distal pulses and capillary refill after the splint

is in place to make sure circulation is still adequate
Use cold compress and elevation to relieve pain and

reduce swelling.

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