First Aid
Fractures
 

​Introduction: 

A bone fracture is a medical condition that occurs when significant pressure is exerted on the bones, caused by: falls, traffic accidents, or bone stress (to which stress fractures in athletes are attributed). Besides, fractures may be attributed to some medical conditions that weaken the bones, such as: osteoporosis and some cancers. Fractures caused by diseases are referred to as pathologic fractures. 

Common fractures are of two types:
  • Closed fracture: where the damaged bone does not tear through the skin; and 
  • Open (compound) fracture: where the skin is torn and penetrated by the damaged bone. Open fractures are more serious.

Symptoms: 
The signs and symptoms of a fracture vary according to the affected area, severity of the injury, and which bone is affected, as well as the patient's age and general health.  However, they often include some of the following: 
  • Pain, swelling and bruising;
  • Discolored skin around the affected area;
  • Angulation: the affected area may be bent at an unusual angle;
  • ​Inability to move the affected area;
  • In the case of open fractures, where the skin is torn: bleeding;
  • When a large bone is affected, such as the pelvis or femur, other symptoms develop, including: skin paleness, nausea and dizziness (feeling faint).

First aid of fractures:
  • Stop bleeding, especially in the case of open fracture where the skin is torn, by wrapping the wound with a sterile bandage or a clean cloth.
  • Avoid moving the affected area; any movement can result in serious complications—especially in the case of neck and back fractures.
  • Cool the affected area by applying and ice pack or ice cubes wrapped in a clean cloth.
  • Treat the patient's shock: help them get into a comfortable position, encourage them to rest, and reassure them. Cover them with a blanket or clothing to keep them warm.
  • Call the ambulance, and help the patient get to the emergency department for examination and treatment.​​

Cast care:
A cast may be used to treat fractures, by fixing the damaged bones. Casts are necessary for better healing, and mitigating the pain caused by bone movement. Therefore, special attention should be paid to the cast, to reduce the risk of complications, and avoid infection. Following are some cast care instructions: 
  • It is common to experience swelling of the fracture area, which results in a feeling of discomfort at first. To mitigate swelling, it is advisable to place the cast on pillows, and elevate it above the level of the heart, for 24 - 48 hours.
  • Use cold compresses, by applying a pack of ice, or a clean cloth including ice cubes, to the swollen area. It is advisable to use compresses for 20 minutes every two hours. But avoid applying ice directly to the skin.
  • Take painkillers (e.g., acetaminophen or ibuprofen) for at least 48 hours to reduce pain. 
  • Keep the cast dry while bathing, and make sure that water does not get into it. Before you bathe, wrap your cast with two layers of plastic. Then put a plastic bag over it. Keep the plastic bag tightly sealed by using and adhesive tape.
  • If the cast gets wet, it must be dried immediately. You may use a hairdryer on a cool setting (never use the hot settings because it might burn your skin).
  • Keep the cast clean, and keep it away from dirt or sand, so as not to be infected.
  • Never insert any objects (pens, etc.) into the cast when feeling itchy. This may damage the skin, and cause infection.

When to see a doctor?
  • When skin rash appears, or foul odor comes from inside the cast;
  • If the cast gets too tight, or too loose;
  • In case of increased pain and swelling, that make movement of fingers more difficult;
  • When feeling numbness or tingling in the arm, fingers or toes;
  • If your fingers feel cold or turn blue;
  • If you feel increased pain inside or near the cast; or
  • If the cast gets too wet to be dried.

Prevention of bone fractures: 
The elderly:
  • Undergo regular medical checkups, and assessments of the risk factors of falls;
  • Undergo bone tests, to check if you suffer from osteoporosis or low BMI—this is especially necessary for women post-menopause, or aged 65 and above;
  • Maintain physical activity, to strengthen foot muscles and improve the body balance;
  • Undergo a yearly eye examination to assess the visual acuity, and update the visual measurements; and
  • Maintain a safe household environment, to avoid falling, by positioning the furniture in a manner that allows for reasonable space, and helps avoid stumbling, as well as maintaining good illumination throughout the house, as a way of avoiding stumbling.

Children:
  • Play safely, and ensure safety of the playgrounds; falls while playing are a common cause of fractures in children;
  • Pay close attention on children while at home, and keeping an eye on them when ascending or descending the stairs, or in any other place where falls are possible; and
  • Exercise safely, by putting on such protective uniforms and tools as: helmets, knee and elbow pads, etc.



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