If we wind up in a situation where the you-know-what has hit the fan, we will be fending for ourselves; we’ll have to do a lot of strenuous activities that we will be unaccustomed to doing, and that means more injuries. Some of those injuries will be minor, but some may be severe such as breaking a bone. Let’s talk a little about fractures and how to identify them without the use of X-rays or other high technology.
What is a Fracture?
When a bone is broken, it is termed a fracture. There are several types of fractures, but they are all either “closed” or “open”. A closed fracture is when there is a break in the bone, but the skin is intact. An open fracture is when the skin is broken. Sometimes the sharp end of a broken bone protrudes through the opening. Needless to say, there is usually more blood loss and infection associated with an open wound. The infection may be in the skin (cellulitis), the blood (sepsis), or the bone itself (osteomyelitis) and could be life threatening if not treated. If poorly managed, a closed fracture can become an open fracture.
Various fractures; all are “closed” fractures except for the second from the left, which is “open”
How to Diagnose a Fracture
The diagnosis of a broken bone can be simple, as when the bone is obviously deformed, or difficult, as in a minimal, “hairline” fracture. X-rays can be helpful to differentiate a small fracture from a severe sprain, but that technology won’t be available in a power-down situation. There are some ways to tell, however:
A fracture will manifest with severe pain and inability to use the bone (for example. The patient cannot put any weight whatsoever on a broken ankle). Someone with a sprain can probably put some weight, albeit painfully, on the area.
More pronounced swelling and bruising will likely be present on a fracture than a sprain.
A grinding sensation may be felt when rubbing a fractured limb.
A deep cut in the area of the injury may be a sign of an open fracture.
Motion of the bone in an area where there is no joint is another dead giveaway that there is a fracture. If you notice that your injured finger appears to have 5 knuckles, you’re probably dealing with a fracture!
Dealing with a fractured bone involves first evaluating the injured area for the above signs and symptoms. Use your bandage or EMT scissors to cut away the clothing over the injury. This will prevent further injury that may occur if the patient was made to remove their own clothing. Check the site for bleeding and the presence of an open wound; if present, stop the bleeding before proceeding further. See our article on treating the hemorrhagic wound: https://www.doomandbloom.net/treating-the-hemorrhagic-wound/
Fractures may cause damage to the patient’s circulation in the limb affected, so it is important to check the area beyond the level of the injury for changes in coloration (white or blue instead of normal skin color) and for strong and steady pulses. To see what a strong pulse feels like, place two fingers on the side of your neck until you feel your neck arteries pulsing. You will do this same action on, say, the wrist, if the patient has broken their arm. To see what normal circulation does to coloring, press hard on your middle finger with your thumb, then release quickly. You will see the compressed area go from white to pink in less than two seconds if your circulation is normal. If the circulation is bad, it will stay white or turn blue. Next, lightly prick the patient in the same area with a safety pin to make sure they have normal sensation. If not, the nerve has been injured.
Evidence of Poor Circulation: white or blue fingertips
If the bone has not deformed the extremity, a simple splint will immobilize the fracture, prevent further injury to soft tissues and promote appropriate healing. Popular commercial splints such as the SAM (Splint, Aluminum, Malleable ) splint are useful but you could improvise by wrapping a pillow around the injury and securing with duct tape. This method gives both immobilization and padding. Even some sticks and strips of cloth from a T-shirt will do in a pinch.
Oftentimes, the bone will be obviously bent or otherwise deformed, and the fracture must be “reduced”, that is, replaced so that the broken ends of the bone are realigned. Although this will be painful, normal healing and complete recovery will not occur until the two ends of the broken bone are realigned to their original position. This is best performed with two people, and will be painful to perform. If you don’t reduce the deformity, however, you will get this:
In this case, you see an obvious fracture of the femur (thighbone) on the left. For one reason or another, this fracture was not reduced. The bone still wants to heal, and the middle E-ray show the bones trying to connect even though the fracture was not reduced. On the right, you see the end result: One leg shorter than the other, and a very likely candidate for a future fracture due to the weakness of the scar.
We’ll discuss more about the procedure to reduce a fracture and other factors in assuring good healing in our next article….