PHYSICAL trauma leading to the fracture of any of the bones in the body is quite a common occurrence all over the world but in Nigeria, injury from traffic accidents is by the far the commonest cause of bone fractures. Fractures also occur from falling from heights, during physical assaults either from a fight or, quite commonly these days from attack by armed robbers.
Irrespective of the cause of the trauma leading to a fracture, the basic things to do as immediate measures are the same – namely to prevent further damage to the soft tissues around the injury site, and to minimize pain.
A fracture is generally described as any discontinuity in the outer covering of a bone and fractures are classified as simple or compound according to their severities. Simple fractures are usually closed fractures in which the skin covering the area of fracture is still intact. Compound fractures are those in which there is skin injury leading to a communication between the fracture and the surface of the body. They generally take longer time to heal.
The immediate concern in any fracture is whether the sharp ragged edges of the fractured bone will puncture a neighbouring blood vessel and this is the main objective of the first aid measures applied at the injury site. Of course the relative movement of the edges of a fractured bone is usually very painful and proper handling is necessary not to aggravate the pain.
Whenever there is a fracture, there are two signs to watch out for immediately: these are tenderness (pain on touching the affected area) and inability to move the affected limb. Later, the area starts to swell. Whenever the above signs occur in a person involved in any trauma- be it a fight, or a road traffic accident, the following measures should be taken:
1. Lie the person flat on a surface. It is easier to nurse somebody with a fracture in the horizontal position than in a sitting position.
2. Gently touch and press the area of the injury and observe whether that elicits more pain or not. Also see if there is a swelling around the area or not.
3. To lift the affected limb, it quite often requires the combined efforts of more than one person. Let somebody hold the limb at the proximal (nearer to the body) end while you hold the distal end.
4. Pull the limb gently towards you and while maintaining the limb in a fairly good alignment with the other assistant, both of you should then lift in unism. If it is the leg, it would be necessary for a hand to be placed below the injury point while moving the limb so that it does not “kick”. Uncoordinated movement of the fractured limb not only aggravates the pain but may cause a fatal bleeding from a punctured blood vessel.
5. Find flat pieces of wood or card-board 2”-4” wide to use as splints. Place 1 to 3 of these splints as necessary below the injured limb and stretch the limb such that it has enough support above and below the area of fracture.
6. Look for other signs of injury- other fractures, areas of bleeding, swellings etc. And attend to them accordingly (see our other health guides) before moving the patient.
7. If the clothings are soaked with blood, remove them carefully, especially those that may interfere with treatment. It is often necessary to cut off the sleeve of a shirt or a leg of a trouser rather than subjecting the fractured limb to unnecessary movements.
8. Cover up the injured person with dry clothings or cover sheets and transfer to a hospital. It is better to use a stretcher, if the fracture is on the leg.