Fracture:
- Cover any wounds.
- Support the injured part above and below the joint.
- Pad around the injury.
- Call 999.
- Treat for shock.
What are fractures?
A break or crack in a bone is called a fracture. In the case of an open fracture, it will present as an open wound or break in the skin near the site of a broken bone. But in a closed fracture the skin around the fracture is intact. However, broken bones may be unstable causing internal bleeding and the casualty may develop shock.
Signs and symptoms
Look for:
- deformity, swelling and bruising around the fracture
- pain and/or difficulty moving the area
- a limb may look shorter, twisted or bent
- a grating noise or feeling from the ends of the broken bones
- difficulty or being unable to move the limb normally. Don't ask the patient to attempt movement if they are unable to.
- a wound over the fracture when the bone is not visible or a wound where you can see the bone sticking out (known as an open fracture)
- signs of shock, particularly with a fracture of a thigh bone, hip or pelvis.
What to do
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Open fractures and long bones - these patients need immediate transfer to A&E by calling 999 or 112.
Suspected broken back, neck or pelvis - these patients need immediate trasfer to A&E by calling 999 or 112.
Smaller/other bones - these patients will need transfer to A&E or an Urgent Treatment Centre, but is less urgent. If possible, the patient can make their own way to hospital via a friend , family member or public transport.
Remove any rings, watches or anything that wraps around the limb as soon as possible.
If it is an open fracture, or these is a visible wound, cover the wound with a sterile dressing or a clean non-fluffy cloth. Apply pressure around the wound and not over the protruding bone or suspected fracture site, to control any bleeding. Then secure the dressing with a bandage.
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Advise the casualty to keep still while you support the injured part to stop it from moving. Do this by holding the joint above and below the injured area.
Place padding around the injury for extra support.
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Ask the patient if they have any changes in the sensation of the affected bone/site:
- feels normal
- pins and needles
- feels hot or cold
- Can't feel anything or numb
If you have not called 999 or 112 for emergency help, do this now.
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Do not move the casualty until the injured part is secured, unless they are in immediate danger. You can secure an upper limb fracture with a sling and a lower limb fracture with broad fold bandages.
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If necessary treat for shock, but do not raise the legs if either are suspected to be broken or there is injury to the pelvis or a hip. Monitor until help arrives.
