Fracture

A fracture is any break in a bone,

including chips, cracks, splintering, and

complete breaks.

Two Basic Types Of Fracture:

Closed Fracture (Simple fracture):

Open Fracture: (Compound fracture)

Closed Fracture (Simple fracture):

Occurs when a bone is broken but

there is no penetration extending

from the fracture through the skin.

Open Fracture: (Compound fracture)

Is a fracture in which there is a wound

over the fracture site, with or without bone

protruding through it.

This type of fracture is more serious than

closed fractures because the risks of

contamination and infection are greater.

Fractures are further classified according to their appearance on x-ray into:

Green stick fracture

Usually occurs in children whose bones are still

pliable (like green sticks)

A break occurs straight across part of the width of

the bone, perpendicular to the long axis

Transverse Fracture

Cuts across the bone at right angles to its long axis

often caused by direct injury

Oblique Fracture

The fracture line crosses the bone at an oblique

angle

Comminuted Fracture:

The bone is fragmented into more than two pieces

Impacted Fracture:

The broken ends of the bone are jammed together

Spiral Fracture:

Usually results from twisting injuries

The fracture line has the appearance of a spring

Causes Of Fractures

Direct Force: The bone breaks at the spot of

application of the force e.g., direct hit over a

bone, bullet injury.

Indirect Force: The bone breaks away from

the application of force somewhere else, e.g.

after falling on outside stretched hands.

Force of Powerful Muscle Actions: For

example, violent cough may cause rib fracture.

Aging and bone disease: Can increase the

risk of fractures (pathologic fractures), with

bones breaking even minor accidents

Twisting Forces: Such injuries are often

seen in football and skiing accidents where a

person's foot is caught and twisted with

enough forces to fracture a leg bone.

Signs And Symptoms Of FracturesThe primary symptom of fracture is PAIN.

Pain is often severe and constant and is felt at or near the site of fracture

Swelling and discolorationThese begin shortly after injuryDiscoloration my start as reddening of the skin

Tenderness Or Discomfort which may lead to severe restriction or use of the area affected

Bone may BREAK through the skinDeformity.

General principles for treatment of fractures

Establish and maintain an open airway

Control hemorrhage

Close sucking chest wound

Begin fluid resuscitation

After dealing with life-threatening conditions, identify

and immobilize all fractures.

Immobilization is accomplished by splinting.

SplintsA splint is a device used to immobilize a

fracture.

Types:Improvised:

Rolled newspaperWoodStrong cartonsCaneIroning boardAny object that can provide stability

Commercially Available Splints:

Rigid splints (padded board, aluminum splint)

Inflatable splints

Traction splints

General Principles Of Splinting:

The clothing is best removed from the area of any suspected

fracture or dislocation

Note and record motion and sensation status distal to the site

of injury

The splint should immobilize the joints above and the joints

below the fracture.

During splint application, minimal movement of the limb

should be allowed.

Severely deformed limb should be straightened with constant

gentle manual traction so that the limb can be incorporated in to

the splint.

If gentle traction increases the patient's pain significantly or if

resistance to the limb alignment is encountered, the limb must be

splinted in the position of deformity.

Cover all wounds with dry sterile dressing before applying a

splint.

Pad the splint to prevent local pressure.

Do not move or transport patients before splinting

extremely injuries.

when in doubt, splint.

Hemorrhage

Hemorrhage means extravasation of blood.

Classification:

- External - Internal

External hemorrhageTypes: Arterial bleeding: loss of blood from arteries

Blood loss is rapid and profuseThe color of blood is bright redBlood spurts as the heart beats

Venous Bleeding: loss of blood from veins

Blood loss is a steady flowThe color of blood is dark

Capillary Bleeding: loss of blood from capillary bed

Blood flow is slowThe color of blood is red but less bright

Methods used to control external bleedingDirect pressure: is a most effective method

Apply direct and firm pressure to the woundElevation of the limbPressure point on the artery Splinting: used in sever laceration or cut

extends over the length of the extremity.Blood pressure cuff: the cuff is placed above the wound, and can be left for up to 30min.

Mast Garments: pneumatic counter-pressure devices for serious abdominal bleeding

Applying Tourniquet: is a last resort used only when other methods to control bleeding have failed.

Internal hemorrhage

Causes of internal hemorrhage:

Deep chest or abdominal wound

Any cut into muscle or fracturing of

bone

Bleeding ulcers

Detecting internal bleeding

: assume internal bleeding whenever the

following are present

Wound that have penetrated the skull

Blood in the ear

Vomiting or coughing up blood

Wound that have penetrated the

chest or abdomen

Large areas of bruised abdomen

Abdominal tenderness, rigidity, or spasm

Blood in urine

Rectal bleeding

Bone fractures mainly the long bone of

the arm or thigh.

Epistaxis

Epistaxis (nose bleeding): means hemorrhage from

the nose, due to mainly spontaneous rupture of

minute vessels.

Local causesTrauma

Nose pickingBlow on the noseForeign body

Infection: acute / chronic rhinitisViolent sneezing Eroding neoplasm in the nasal cavity,

nasopharynx, or sinuses.

General and systemic causes

Hypertension

Blood diseases

Acute infectious fever

High altitudes

First aid treatment

Apply pressure by pinching the

nostrils

Keep the patient in a setting position

Apply ice over the nose

Keep the patient quite

Hospital emergency careSimple packing of the nose

Use of adrenaline nasal pack

Use of diathermy

In hypertension cases: sedation and reduce

blood pressure

Check for blood coagulative disorders.