Fracture: Do's and Don'ts. First aid for fractures What should be done in case of fracture of the limbs briefly
![Fracture: Do's and Don'ts. First aid for fractures What should be done in case of fracture of the limbs briefly](https://i0.wp.com/studfiles.net/html/2706/954/html_1511O4_Gla.hw9S/img-3E7uxc.png)
fracture called partial or complete violation of the integrity of the bone as a result of its impact, compression, compression, bending. After a complete fracture, bone fragments are displaced. With an incomplete fracture, the bone is partially damaged - a fracture, a crack is formed. Fractures happen closed(no skin damage) open(with violation of the integrity of the skin) and complicated(bleeding, crushing of surrounding tissues).
Fracture signs: pain, swelling, change in shape and shortening of the limb, the appearance of mobility at the site of injury, the “crunch” of fragments. A fracture is always accompanied by soft tissue damage. Damage to large vessels and nerve trunks is especially dangerous, formidable companions of which are acute blood loss and traumatic shock. In the case of an open fracture, there is a risk of infection of the wound.
In case of fractures, providing first aid, in no case should you try to compare bone fragments - to eliminate the curvature of the limb with a closed fracture or set the bone that has come out with an open one, because. fragments, moving, often damage blood vessels, nerves and internal organs. In case of fractures and injuries of the joints in first aid, the main thing is reliable and timely immobilization of the damaged part of the body, which reduces pain and prevents the development of traumatic shock, eliminates the risk of additional damage and reduces the possibility of infected complications.
Temporary immobilization in case of bone fractures is usually carried out using various splints made of various materials: wood, plastic, metal, rubber. Tires must necessarily ensure the immobility of the two joints adjacent to the fracture site. In the absence of standard ones, improvised means can be used: boards, sticks, plywood, cardboard, etc. In exceptional cases, transport immobilization is allowed by bandaging the injured limb to a healthy part of the body: the upper one to the body, the lower one to a healthy leg.
Fracture of the bones of the skull. Broken bones often damage the brain, it is compressed as a result of hemorrhage. Signs of a fracture are: violation of the shape of the skull; break (dent); leakage of cerebrospinal fluid and blood from the nose and ears; loss of consciousness.
To fix the neck and head, a collar made of soft fabric is applied to the neck. To transport the victim, they put it on a stretcher, put a soft bedding with a recess under the head, and on the sides - soft rollers rolled up from clothes or other available material.
For fractures of the upper jaw the easiest way to immobilize is a circular bandage from a bandage or scarf. When it is applied, the lower jaw is pulled up to the upper jaw until the teeth close and fixed in this position by vertical bandage moves around the head or with a scarf. In cases where the teeth do not close, a strip of plywood or a piece of a ruler is inserted between the jaws and pressed against the upper jaw.
Fracture of the lower jaw can lead to asphyxia (suffocation). If a person is unconscious as a result of an injury and lies on their back, the tongue may retract and immediately suffocate. It is necessary to give the victim a sitting position with his head bowed or put on his stomach with his head turned to one side. Sometimes they resort to flashing the tongue with a pin and provide immobilization of the lower jaw.
With a fracture of the humerus the forearm is bent at a right angle in the elbow joint, and two splints are placed on the broken shoulder bone: one from the outside of the shoulder, and the other from the armpit to the elbow joint. Then both tires are bandaged to the shoulder and the bent forearm is hung on a belt or scarf.
In the absence of a service splint (Fig. 12, a) or improvised means, the arm bent at the elbow is hung on a scarf, belt and bandaged to the body (Fig. 12, b).
Rice. 12. Immobilization in case of fracture of the humerus
Clavicle fracture more common when falling on an outstretched hand. Medical assistance should be aimed at immobilization of the upper limb belt (Fig. 13, a).
Rice. 13. Fixation of hands in case of fracture of the collarbone
A lump of cotton wool is placed in the armpit from the injured side and the shoulder is tightly bandaged to the body, and the forearm is suspended on a scarf, the hand is attached to the body with the second scarf. The injured hand can be placed on the raised floor of the jacket (Fig. 13, b).
Rib fractures accompanied by pain in breathing. Immobilization - a tight bandage on the chest. The first moves of the bandage are made in the state of exhalation of the victim.
spine fracture – the most severe and painful injury. Even slight displacement of bone fragments can lead to death. Therefore, the victim with a spinal injury is strictly forbidden to plant or put on his feet. He should first be injected with an anesthetic (morphine, promedol, analgin, etc.), and then laid on a flat solid shield or boards (Fig. 14).
Rice. 14. Tires from boards for a fracture of the spine
It is necessary to lift the victim with a fracture of the spine very carefully, in one step, so as not to cause displacement of fragments and more severe damage to the spinal cord and pelvic organs. Several people can lift the victim, holding his clothes and acting in concert, on command (Fig. 15).
Rice. 15. Putting the victim on a stretcher
In the absence of such a shield, the victim is laid lying on his stomach on an ordinary stretcher, placing pillows or rollers under his shoulders and head (Fig. 16).
Rice. 16. The position of the patient with a fracture of the spine
A person with a fracture of the cervical spine should be left on his back with a roller under the shoulder blades, fix the head and neck, covering them on the sides with soft objects.
Fracture of the pelvis. It is impossible to lay the victim on a soft stretcher, it is possible only on a shield (wide board, plywood) or on a stretcher, putting plywood on them (Fig. 17). The victim is placed on his back, the legs are spread apart (“frog position”) and a dense roller of a folded blanket, rolled up clothes is placed under the knees: In this position, the limbs are fixed with spacers and bandages.
Rice. 17. The position of the patient with a fracture of the pelvic bones
With a fracture of the bones of the forearm the arm in the elbow joint is bent at a right angle with the palm to the body. The tire is taken so long that one end covers the fingers of the hand, and the second goes beyond the elbow joint. In this position, the tire is fixed with a bandage, and the hand is hung on a scarf or belt.
Fractures of the bones of the hand andfingers. Damaged half-bent fingers (give a “grasping” position of the hand) are bandaged to a cotton roll, hung on a scarf or splinted.
For fractures of the lower extremities a transport splint is usually applied to a straightened leg (Fig. 18). In this case, you must have at least two large tires. One of them is applied along the outer surface of the limb, while one end of it should be under the arm, and the other should protrude slightly beyond the foot. The second tire is applied along the inner surface of the leg so that one of its ends reaches the crotch area, and the other protrudes beyond the edge of the foot. In this position, the tires are bandaged to the body.
Rice. 18. Methods of immobilization
with fractures of the lower extremities.
In the absence of service splints or improvised means, the injured leg should be bandaged to a healthy leg.
In case of fractures of the bones of the foot, a plank is bandaged to the sole.
All methods of immobilizing dressing should provide good fixation of the fracture site, not disrupt the blood supply to the injured limb. Therefore, when applying a transport splint, it is necessary to ensure immobility in the joints above and below the fracture site.
To prevent severe squeezing and pain, the tire is wrapped with cotton and a bandage. With an open fracture, bleeding is stopped, an aseptic bandage is applied to the wound, and only after that immobilization is started.
Leg fractures are divided into three main types: open (with damage to the soft tissues and external integument), closed and intra-articular. In the latter case, the fracture occurs inside the joint capsule, where blood can accumulate (hemarthrosis, for example, with a fracture of the femoral neck).
Fractures, including those of the lower extremities, depending on the cause of occurrence, are usually divided into pathological (caused by a disease, for example, osteoporosis) and traumatic, i.e. resulting from trauma. For example, a “bumper fracture” after a road traffic accident is considered traumatic, and a femoral neck fracture as a result of a decrease in bone density in a woman after 40 years is referred to as pathological fractures.
Symptoms of leg fractures
- Severe pain at the site of injury;
- Change in the length of the affected leg compared to the healthy one. If the victim's legs are extended in length (if it hurts, do not touch), this symptom is clearly visible. In addition, due to tissue edema, the transverse size of the limbs may also differ;
- Restriction of movement in the affected leg, increased pain during movement;
- The appearance of abnormal mobility in places where it should not be, i.e. at the site of the fracture.
Open fracture of the lower extremities
Damage to the skin creates ideal conditions for the penetration of tissue infection, up to sepsis. In addition, an open fracture is often accompanied by bleeding. Multiple open fractures of the legs may be accompanied by traumatic shock.
As a rule, open fractures occur during falls from a great height, traffic accidents, at work, or as a result of participation in hostilities. The healing process for an open fracture can take many months.
The first thing to do with an open form of leg fracture is to stop the bleeding. Since the blood in the arterial vessels is under pressure, if a large artery is damaged, the victim "drains" in a matter of minutes.
If everything happens on the road, each driver should have a tourniquet in the first aid kit. Apply the tourniquet 10 cm above the fracture, tighten until the bleeding stops. If there is no tourniquet, take any clean rag (if there is no clean one, cut off the sleeve from the shirt), a stick (strong enough, of any origin) and “twist” the rag with a stick until the bleeding stops (we fix the stick).
If you put a tourniquet on your leg, but you couldn’t get to the hospital right away, never remove the tourniquet yourself. Decay products accumulate in the leg, because. venous outflow is also disturbed. If the tourniquet is removed, the patient may die from decompression toxic shock (well, from newly discovered arterial bleeding, incl.).
A similar situation occurs with people removed from under heavy objects. If you are faced with a situation where, say, a tree fell on a person’s leg, find out how many people have been under it. If more than half an hour, then before removing it, you need to apply a tourniquet above the place that turned out to be pressed down. If it is impossible, wait for the ambulance and the Ministry of Emergency Situations; you should not remove the victim yourself.
Compression fractures are very insidious - the victim can feel great after being released from the pressure factor, and die a few hours later from kidney failure.
After stopping the bleeding, it is necessary to properly immobilize. Immobilization refers to conditions under which the affected leg does not move.
Immobilization of patients with leg fractures
It is carried out for any leg fractures, especially if the fracture is accompanied by bleeding, muscle injuries or burns. Immobilization prevents the destruction of blood vessels, nerve fibers and soft tissues by bone fragments. This not only reduces pain in the patient, but also reduces the risk of shock, blood loss and septic complications.
Immobilization is performed for several hours, sometimes up to 2 days (if the hospital is far away).
For its implementation, transport tires are used, they are wooden or wire. The length of the tires is about a meter, the width is from 5 to 10 cm. Wire tires are easily modeled “along the leg”. A convenient thing, in a word, only immediately after a fracture they are almost never available, and sometimes you have to deliver the victim yourself.
As tires, as a rule, improvised material is used - skis, rods, pieces of plywood or boards. The main thing in applying a splint is that the areas of the bone adjacent to the damaged segment are motionless. In other words, we immobilize both adjacent joints.
Example: in case of a bumper fracture (standard bumper impact to the shin), the tire is fixed with bandages to the thigh, shin proper and foot. Otherwise, the movement is transmitted, which causes pain and increases the risk of fracture complications, including dislocation of the femoral head of the affected limb.
If the fracture was open, a bandage should be applied before immobilization. Otherwise, the risk of infection increases significantly, and changing tires is quite uncomfortable for everyone.
If you have painkillers with you, give them to the patient immediately. In any case, it is better to anesthetize before immobilization, which will significantly help reduce the risk of painful syncope in the victim.
When we apply a hard tire (homemade tires are hard), then the place of contact with the skin or bone fragments should be softened with cloth or cotton wool (this is about areas where there are no clothes).
The splint is applied from the side opposite to the fracture, i.e. the splint should not come into contact with the protruding bone.
If you are not going to take the victim to the hospital on your own, there are no traffic jams and the ambulance is about to arrive - do not torment the patient. Immobilization is needed primarily for the transportation of the victim, and a non-specialist performs it only in emergency circumstances (accident on the highway, for example).
Types of splints for immobilization
In no case do not try to “reset” the fracture on your own, align the limb. Such attempts bring nothing but harm, but the pain shock in the patient is caused quite easily.
If the fracture is open, the skin around the wound is lubricated with iodine solution (or any available antiseptic). The wound itself cannot be wetted - it is very painful, worsens the prognosis and slows down subsequent tissue regeneration(a burn is added to the wound).
At least two are needed for immobilization. The first gently lifts the limb, making sure not to disturb the deformed part of the limb, the second fixes the splint to the limb. You need to start fixing from distant areas to the fracture. It is important to leave the ends of the toes open, since their condition can be used to judge the circulation in the leg (except when it is the toes that are injured).
If the fingers begin to blush (turn blue), get cold and become painful (or sensitivity disappears altogether) - as a result of a fracture (or a tourniquet), the blood supply was disrupted. When delivering the patient to the hospital - pay the attention of the doctor to this fact (it will not hurt).
- With a fracture of the femur- the tire is total, i.e. from the foot to the armpit on the outside, and from the foot to the groin on the inside. Thus, if we are talking about a hip fracture, there is (knocked together) a stick from the armpit to the foot and from the groin to the foot for the internal splint;
- If the shin is broken- the tire is superimposed from the toes to the upper third of the trouble;
- With a broken foot- from the fingers to the upper third of the lower leg. It is also desirable to impose two side tires. It is best when flexible tires are at hand. One is applied from the fingers to the sole, then bent at a right angle and continued along the back surface of the lower leg to the knee joint. The side tires are applied in the form of the letter V so that it fixes the plantar part of the foot (according to the stirrup principle).
Tires must be bandaged tightly, carefully, at least in 3 places.
As a last resort, let's consider the option of fixing the injured leg to the healthy one, i.e. foot-to-foot method. The effectiveness of this method is quite low, but it is significantly better than transporting the patient without immobilization at all. Transportation should be carried out on a stretcher, in a supine position. If there is no stretcher, use outer clothing plus strong sticks.
In no case do not leave the victim alone, he may lose consciousness and suffocate at any moment. Keep ammonia on hand - it is advisable to keep the patient conscious until the arrival of medical workers. The sooner the patient gets to the traumatologists, the better. Do not allow the patient to get to the hospital on their own, even with minor (at first glance) fractures.
After the patient receives all the necessary assistance, it is necessary to take a course of anticoagulants to prevent thrombosis. Do not be surprised at the high price of this group of drugs - their use significantly reduces the risk of sudden death from a heart attack, stroke, pulmonary embolism (PE) and other complications of thrombosis. This situation is especially relevant for patients with an open fracture of the lower extremities - the vessels are large, therefore, extremely dangerous (large) blood clots are formed.
There are several types of foot injury:
- single injury (only two bone fragments are present after the injury);
- double damage (most often occurs when a fracture of the femur or lower leg is combined with an injury to large blood vessels, nerve endings and other soft tissues);
- comminuted and multi-comminuted injuries (such injuries occur when the bone is crushed into several particles of different sizes);
- violation of the integrity of the bone with displacement of bone fragments.
Causes
Damage can occur as a result of any pathology or traumatic impact. Causes of damage in case of mechanical injury:
- a strong blow to the area of injury;
- fall from a hill;
- intense compression of the bone;
- manufacturing flaws;
- non-compliance with safety rules;
- adverse weather conditions;
- sports activities.
Causes of pathological damage:
- osteomyelitis or osteoporosis;
- syphilis infection;
- the presence of cancer of the bone tissue;
- tuberculosis;
- the presence of fibrous dysplasia.
Symptoms
The first signs of a broken leg:
- intense pain at the site of injury;
- the damaged limb becomes shorter;
- deterioration in performance;
- increased pain even with slight exertion;
- the occurrence of swelling of soft tissues;
- the formation of hematomas, bruises, scratches and abrasions;
- visual change of the leg in the broken place;
- crepitus (crunching of bone fragments) during palpation and exercise.
First aid
In the event that a fracture of the lower limb has occurred, then it is necessary to immediately and correctly provide first aid. The first thing to do is to relieve the pain. With intense pain, it is required to immediately provide the victim with any non-steroidal pain reliever available in your home medicine cabinet. The next step is to immobilize the injured leg. For the immobilization procedure, various auxiliary items can be used: umbrellas, sticks, cardboard boxes, boards. In the most comfortable position, the splint is attached to the injured leg with ropes, bandages and straps. In the event that an open fracture occurs, the hemorrhage should be stopped immediately and the wounded area should be treated to avoid infection. After all first aid actions have been completed, go to the nearest hospital, where experienced doctors will conduct specialized studies and prescribe the most suitable treatment for you.
Medical tactics
Treatment depends on the severity of the injury, its location and nature. In the case of uncomplicated fractures without significant displacement of the fragments, conservative treatment is prescribed. It consists in the fact that the doctor, if necessary, performs a procedure for firmly matching the displaced fragments, and then immobilizes the injured limb for a certain period of time using a plaster cast or other fixing objects. The duration of the immobilization period is assigned individually for each, depending on the complexity of the fracture that has occurred.
Surgical treatment is performed in case of more severe injuries with significant displacement or comminuted fractures. The task of the doctor during the operation is to compare the displaced fragments (during displacement), remove the chipped particles (comminuted pearl) and fix the limb in one position, which is carried out using immobilizing metal structures (pins, plates, knitting needles). After the operation is completed, the leg is also immobilized with a plaster cast for a period of time prescribed by the doctor. After complete restoration, the metal structures are removed.
A fracture is a common type of injury in which there is a violation of the integrity of the bone. Fractures are divided into complete and partial (cracks), as well as closed, when the skin is intact, and open, when a gaping wound formed by bone fragments appears at the fracture site.
A fracture is a serious injury and always requires medical intervention, so in all cases where there is a suspicion of a fracture, medical attention should be sought. The goal of first aid for fractures is to ensure rest of the injured area (in order to prevent damage to muscles and tendons), to alleviate pain if possible and to get the victim to the hospital as soon as possible to provide qualified medical care.
Signs of a fracture
The main signs of a fracture that has occurred are intense pain, swelling, and abnormal mobility in the injured area. There are additional signs that depend on the type and location of the fracture, but in order to suspect a fracture, three main ones are enough, and sometimes even one - severe pain. The fact is that swelling is not always noticeable to an inexperienced eye. For example, in people with a dense physique, it can be difficult to detect, and in some cases it may not be too pronounced. As for pathological mobility, it also cannot always be detected, for example, if the fracture is located close to the joint.
The doctor will be able to accurately determine the presence of a fracture after an x-ray, and for first aid it will be correct to consider any bone injury that is accompanied by severe pain that increases when you try to move as a fracture. If later it turns out that the injury is less serious, for example, a bruise or dislocation, and first aid is given as for a fracture, this will not bring any harm to the victim, while underestimating the severity of the injury can lead to very serious complications.
First aid measures for fractures
First aid for a fracture is immobilization, i.e. immobilization of the injured part of the body, and the speedy delivery of the victim to a medical facility. When carrying out immobilization, it is important to follow the general rules:
- No need to try to give the injured bone the correct shape. This can lead to pain shock, as well as additional (secondary) injury to soft and hard tissues;
- If the fracture is open and broken sections of the bone are visible, you should not try to "push" them into the soft tissues. With comminuted fractures, it is not necessary to try to remove or set the fragments. It is necessary to immobilize in the position in which the affected area is located at the time of first aid;
- You can not transport the victim with multiple injuries, including multiple fractures, as well as fractures of the spine and pelvis. First aid for fractures of this type is provided on the spot, and an ambulance is involved in delivery to the hospital;
- With intense pain, you can give the victim an anesthetic. Paracetamol, Analgin or any other over-the-counter pain reliever will do;
- In the cold season, it is necessary to ensure that the victim does not get cold, including that the injured limb does not get cold. To do this, you can throw some warm clothes or a blanket on her, and give the victim hot tea to drink (if possible).
Immobilization rules for various fractures
Before transporting the victim to the hospital, the affected area must be fixed so that movements in this area do not aggravate the injury.
Fractures of fingers and toes:
In case of fractures of the fingers or toes, for immobilization, it is enough to bandage the injured finger to the next one.
Limb fractures:
In case of fractures of the limbs, a splint is applied. The splint can be made from any material at hand that is strong enough to keep the limb stationary.
It is necessary to apply a tire, observing the following rules:
- The tire is installed in such a way as to fix at least two joints - located above and below the fracture site;
- There must be a tissue layer between the tire and the skin;
- The tire must be firmly fixed, it is unacceptable for it to hang out, because. in this case, instead of a means of immobilization, it turns into an additional traumatic factor.
Rib fractures:
In case of rib fractures, the victim needs to apply a tight, pressure bandage on the chest, the purpose of which is to exert sufficient pressure so that the person breathes more due to the abdominal muscles - this will provide fixation and reduce pain, since the chest moves when breathing. You should not talk to the victim, as speech also leads to increased soreness.
Fractures of the spine and pelvis:
In case of fractures of the spine and pelvis, as well as multiple fractures, the victim should not be moved, this should be done by people with sufficient qualifications. However, if this is not possible, in order to provide first aid for fractures of this type, it is necessary to make a stretcher with a solid base, observing the maximum precaution, transfer the victim to them. It is necessary to put a cloth roller under the knees (you can use folded clothes), then fix the patient on a stretcher with wide bandages or tissue replacing them and transport them, avoiding sudden movements.
First aid for open fractures
First aid for open fractures generally consists of the same measures as for closed ones, however, in this case, it is necessary to stop the bleeding, since large blood loss is more dangerous than the most complex fracture. To stop bleeding, a bandage should be applied, and if necessary, a tourniquet (see "First Aid for Bleeding"). It is desirable to treat the surface of the wound with an antiseptic (alcohol, iodine), but scraps of tissue, fragments, etc. should not be removed from the wound.