Fractures

A fracture is a broken bone. A child's bone, containing less calcium and phosphorus than an adult's, often cracks and bends without breaking completely. This is a "greenstick" fracture. The common type of fracture of an adult bone is spoken of as a simple fracture with the break usually straight across the shaft of a big bone and no broken ends protruding. The more severe type of fracture, in which the ends of the broken bone pierce the muscles and skin, is called a compound fracture. This is more serious, damaging other tissues and causing danger of infection.

Caring for a fracture victim involves preventing or reducing the danger of shock, preventing further injury (as damage to blood vessels and nerves) and relieving pain. When doubt exists as to whether a bone has been fractured, the patient should be handled as though there is a broken bone. Usually the first-aider can make a good guess by remembering the usual indications of a fracture: Something' 'pops" or the injured person feels a sudden" snap" the site of a fracture is tender to the touch and painful; swelling usually develops; the injured part may be out of shape; usually the victim guards the injured part of his body, avoiding any attempt to use it; sometimes moving the injured part produces an uncomfortable grating of the bone; if a leg or an arm is broken, the injured limb may appear shorter than the other; in a compound fracture the bone protrudes through the wound.

Caring for Fractures
Fractures should always be set by a physician, especially compound fractures, and preferably in a hospital. The first-aider's duty is to care for the victim while waiting for the ambulance or doctor. Treatment for shock (see Shock: Shock From Failure of Blood Circulation), application of cold cloths or an ice bag to the injured area to relieve pain, the bandaging of a compound fracture, and proper splinting of the injured part in preparation for transporting the victim are responsibilities of the first-aider.

In case of a compound fracture, the first-aider should attempt first to control hemorrhage. (See Hemorrhage.) If this is profuse, he should cover the wound with sterile surgical dressings or clean cloths and bandage these snugly in place.
Avoid moving the victim more than necessary. Splints and sup ports should be applied where the injured person lies, so that when he is moved there will be no further damage to his tissues from the sharp ends of the broken bones.

Splints can be made from boards, sticks, magazines, newspapers, or pieces of corrugated carton. A splint should reach above and below the injury far enough to prevent movement of the broken bone. If an arm or leg has been broken, the part should be gently straightened and placed in as natural a position as possible before the splint is applied. Strips of cloth, neckties, leather belts, or bandages maybe used to fasten the splint in place.

CAUTION
If it is the back, the neck, the pelvis, or the skull that is injured, great precautions must be taken before moving the patient.

A. Fracture of the Arm. In a fracture of the arm (between shoulder and elbow) the injured member should be bandaged to the body.

B. Fracture of the Back. The grave danger in handling a person with a broken back is in possible damage to the spinal cord, resulting in lifelong paralysis. Plan your handling of such a victim before you move him at all. Commandeer the help of at least three other persons in placing the victim on the stretcher. The spine must not be bent, twisted, or overextended. In a fracture of the spinal column at any level, the victim must be transported on his back, with small bolsters to support the small of the back and the neck. In placing him on the stretcher, which should be made rigid if not already so, make sure that the four people who handle him move in unison so as to reduce the danger of damage to the spinal cord. The patient should be firmly attached to the stretcher to avoid accidental fall and further injury.

C. Fracture of the Forearm. After other possible complications such as shock and hemorrhage are cared for, the injured forearm is splinted and then placed across the victim's chest.

D. Fracture of the Hip. This fracture is serious, particularly in elderly people. Treatment requires a physician's services and prolonged hospital care. For transporting the victim, a firm splint must be used for the entire length of the victim's body and injured leg. Tying both limbs together is also a method of splinting.

E. Fracture of the Leg. After taking care of the possibility of shock and controlling hemorrhage, if present, prepare the victim for transportation by splinting his leg.

 F. Fracture of the Neck. A broken neck is one of the most serious injuries possible, often resulting in death. The possibility of a broken neck must always be borne in mind when handling an accident case where the victim has been thrown against some solid object. It is best not to move such a person until a doctor or skilled ambulance crew arrives. If such help is not available, then the victim must be handled in a manner similar to that for broken back: The victim is placed on the improvised stretcher lying on his back with a small bolster under the neck. One of the four people who assist in moving the victim must hold the head at all times so that it remains in line with the rest of his body this to prevent further spinal cord injury.

G. Fracture of the Pelvis. Most fractured pelvises are the result of serious automobile accidents, usually associated with other serious injuries. Generally, combating shock constitutes a major problem. Before transporting the patient, place a large bandage around his pelvis to support it in corset fashion. As a preparation for transportation, the victim should be placed on a firm large board and his legs fastened securely together and to the board to avoid movement of the broken bones.

H. Fractures of the Ribs. (See Chest
Injuries: A. Fractured Ribs.)

I. Fractures of the Skull. (See also
Head Injury.) Usually, in fracture of the skull, the patient is unconscious. Other signs are bleeding from ears, nose; or mouth, and an inequality of the size of the pupils of the two eyes. In some severe cases, watery fluid escapes from the ears or nose along with the blood.

WHAT TO DO
1. Keep the victim perfectly quiet, lying on his back. Do not permit him to move, sit up, or stand.
2. Turn his head slightly away from the injured side.
 3. Keep the patient warm by covering him with blankets.
4. Arrange for transportation to the hospital at once, but do not crowd him into a sitting position to move him. He should be supported by a firm stretcher and kept in a reclining position.
5. Do not give stimulants, liquor, or pain-killers.

FROSTBITE
Frostbite is an actual freezing of the tissues of exposed parts of the body such as ears, nose, hands, or feet. Just before the tissues become frozen, they may appear violet-red. Once freezing has -occurred, color changes to gray yellow.

WHAT TO DO
1. Avoid rubbing the frozen parts, and do not massage with snow.
2. After placing the victim in a warm room, remove all items of clothing that constrict the frozen part-boots, gloves, or socks.
3. Immerse the frozen part in warm water (not hot) and attempt to raise the temperature of the frozen tissues gradually to normal body temperature. When the nose or the ear is frozen, use compresses wrung from warm water to thaw the frozen part.
4. Try to improve the victim's condition by keeping him warm and giving hot drinks (not alcohol).
5. After the frozen part has thawed, keep it dry and avoid the use of wet dressings.
6. Avoid pressure of heavy bed clothing or other objects against the part that was frozen, protecting the part by a "cradle" placed over it.
7. Encourage the victim to move the part that was frozen, for this will increase blood circulation. However, he should avoid standing on a previously frozen foot until it is completely healed.