In survival settings, the family medic will be confronted with a variety of orthopedic injuries. They might be injuries to joints like sprains, to muscles like strains, or to bones like contusions or fractures. We are often asked how to tell the difference between a sprain and a fracture. Sometimes it’s quite easy, as when, due to trauma, a straight bone is suddenly “zig-zag”(!) in shape. Many times, however, it’s hard for even an orthopedic surgeon to determine without modern diagnostic tests. Needless to say, this is not an option when the you-know-what hits the fan.

There are certain signs that can help make the diagnosis without high technology. One simple one is that sprains involve joints: Injuries in the middle of a bone are more likely a fracture or other injury, although a bone contusion (bruise) is a possibility in some cases.

Look for one or more of these signs to differentiate between a sprain and a fracture:

• A sprain will generally have less pronounced swelling and bruising than a fracture.
• A person can usually walk a few steps both immediately and an hour later with a sprain. A fracture is generally so painful that no pressure may be placed on the injury at all.
• Sprains are rarely associated with breaks in the skin, but fractures may (an “open” fracture”).
• Swelling on one side of a joint (for example, an ankle) is more likely to be a sprain. Swelling on both sides suggests a fracture.
• A fracture may show motion in an area beyond the joint (if your finger suddenly has five knuckles, you probably broke it).

Ankle and certain foot fractures can be diagnosed without modern diagnostic devices by following the Ottawa Rules, described below in this video:

For sprains, Ibuprofen serves as an excellent anti-inflammatory and pain reliever. Natural remedies may also help. The green underbark of willow, aspen, and poplar trees contains Salicin, a natural pain medicine from which the first aspirin drugs were manufactured.

Most sprains, (such as wrist and ankle sprains) commonly heal well over time using the famous R.I.C.E. protocol, pain relievers, and a lot of rest. Others, however, such as severe knee sprains with torn or ruptured ligaments, may heal completely only with the aid of surgical intervention.

It’s important to get joint issues dealt with while there is still a functioning medical infrastructure in place. During uncertain times, you (and your joints) want to be in the best shape possible to face the challenges ahead.

Bone Contusions

An injury that can mimic either a joint sprain or a partial fracture is the “bone bruise,” otherwise known as a “bone contusion.” It occurs when an impact causes a small injury on the surface of a bone, but doesn’t fully fracture it. The “periosteum” is a layer of tissue that covers most bones. Trauma could cause blood and inflammatory fluid to build up beneath it.

Although any bone can be involved, it usually affects those closest to the skin, such as the knee or shin. Bone contusions that happen in joints may be accompanied with , tears (sprains) as well. Fractures may have occurred nearby.

One way to identify a fracture versus a contusion is with two basic tools: the tuning fork and stethoscope. Strike a tuning fork (128 hertz will do) on a surface and then on the bone below the level of the fracture (away from the torso). Then, place a stethoscope above the level of the fracture (closer to the torso). In a fracture, sound will be decreased in a fracture compared to a contusion on intact bone. Compare with the opposite, uninjured side.

Simple bruises, also known as “ecchymoses,” appear reddish-brown to purplish-black, but bone bruises will have more symptoms. They include:

• Pain, often throbbing or aching.
• Swelling.
• Difficulty using the affected area.

A sign that you’re dealing with more than a minor injury is if there is long-standing swelling or increasing pain. Any areas beyond the injury, such as fingers or toes, that lose color or sensation is another diagnostic sign.

Rest and pain relievers like naproxen (Aleve) or ibuprofen (Advil) may be all you need. For the first 48 hours, cold packs may decrease swelling. Be sure to place a barrier between the cold pack and traumatized skin. In leg injuries, elevation of the site above the level of the heart will also help relieve swelling.

If the skin if broken from the trauma and turns red and hot or if there is fever, the patient may have developed cellulitis, something we’ve talked about before on this website, and require antibiotics. cephalexin 500 mg orally 4 times a day, sulfamethoxazole/trimethoprim 800/160 mg twice a day and clindamycin 300 mg 4 times a day for a week to ten days are reasonable options off the grid and available in veterinary equivalents. Antibiotic cream should be applied to any broken skin, which should be kept clean.

Bone contusions are often the result of trauma from strenuous activities of daily survival. Victims should be placed on light duties until fully healed. Unfortunately, these types of injuries may linger for weeks or months until fully healed. Addition of extra vitamin D and calcium to the diet may help speed recovery.

Joe Alton MD

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