Posts Tagged ‘fractures’

A fracture is the separation of bones of living creatures into two because of stress. Following are a few types of bone fractures.

Fractured Ribs

These are often left untreated after X-ray or medical diagnosis. However, if the discomfort is marked (usually worse on coughing or sneezing), support the fracture with the arm bandaged to the side of the trunk with wide bandages. If the discomfort is increased (which may occur), loosen the bandages. If there are obvious internal problems as well, the sooner expert help is gained the better.

Fractures of the Lower Limb

Fractures of the Femur

This is the single long bone of the upper part of the lower limb (referred to as the thigh). There arc two main types, (a) the neck of the femur, and (b) the shaft of the femur.

Fractures of the neck of the femur are common in aged persons who slip or trip. There is pain over the hip and reduced power in the limb. Often the limb is shorter, the foot rolled outwards, and pain on moving the limb. With the patient lying on the back, the injured limb is gently lifted with both hands over onto the uninjured one until the feet cross.

This gives it good support and acts as a splint. The feet and knees and thighs arc then bandaged together. This is a common injury, and old people often get up and walk afterwards, so a careful examination is necessary.

Fractures of the shaft of the femur often result from a major accident, such as a car smash. The bone is large and thick, and it can withstand a lot of force before being broken. Therefore it is often a violent injury, and there may be other fractures or signs of injury also. There will be a lot of pain, probably shock from blood loss (which may be extensive), swelling and deformity. There will be limb shortening. The injured limb is bandaged to the uninjured one several times with a liberally padded splint between the two limbs. If possible, a long splint extending from under the arm to the feet may also be used, and bandaged firmly to the body and lower limbs.

Fractures of the Patella (Kneecap)

This will produce tenderness, pain and swelling over the kneecap. Place a splint well padded under the buttocks and extending to the heel, and bandage firmly to lower limb above and below knee. Elevate lower limb at foot level.

Fractures of the Tibia and Fibula

These are the two bones of the lower part of the leg. The tibia is a very heavy, firm bone, and the fibula is a very thin, narrow bone external to the tibia. Tibial fractures occur mainly in violent accidents, such as those involving motor cars. Place a padded splint between the limbs extending from the groin to the feet. Bandage the two legs, above and below the fracture site, and also above the knees for stability. Elevate if possible.

Injuries around the Ankle and Foot

These are far more common, and may occur during rough contact sports.

Place a padded splint under the foot, along the sole from heel to toes. Bandage firmly and extend the bandage around the ankle region several times. Raise and support the injured foot.

As fractures of the lower limbs, especially of the long bones, are potentially serious, and often follow violent accidents, expert help (such as the ambulance) is often preferable to fiddling with it yourself, particularly if you are inexperienced. Getting the patient to the emergency ward of a hospital is the ideal, and the quicker this can be done the better, especially if there are signs of shock and blood loss, or if the wounds are open. These major fractures often need surgical reduction and repair.

Fractures of Face and Jaw

Pain on jaw movement, difficulty in closing the mouth, speaking and swallowing, bleeding and damage to soft tissues, swelling and local deformity may indicate fractures at this site. These may follow a violent accident such as with motor vehicles. It is essential that a clear airway be maintained, and saliva, blood and loose teeth be removed if possible. If unconscious, patient should be placed into the stable side position.

Fractures, Dislocations and Sprains

This is always a gloomy subject, for I hate the idea of children hurting themselves. A sudden injury can convert a happy little group into a sad one, and this is always a sorry sight.

Fortunately, breaks in the bones, called fractures, are not very common in children, and many of them involve bones bending and probably splitting rather than being jagged, serious injuries as they frequently are in adults.

What Can Happen?

Fractures usually result from accidents. The bigger and more serious the accident, of course, the greater are the risks of bones being more severely injured. Many accidents are fairly minor, such as falls from bikes, skateboards, or falls from fences and trees and similar sporting-type accidents.

Broken bones usually result in some degree of deformity. The limb may be bent abnormally. There may be pain and swelling, and it may be difficult to move it normally. As time advances, fluids accumulate in the tissues and the swelling increases. If blood vessels have been broken internally, this will increase the swelling. Of course, other internal injuries may also be involved, and these may be even more important and life endangering. A fracture that breaks the skin is much more serious.

Often there may be signs of shock, as the system reacts to the pain and internal derangement of the bones. Sometimes joints are involved, and pulled from their normal position. This is called a dislocation.

A sprain means the fibers encircling the joint have been overstretched or torn. This will cause swelling and pain, and is common around the ankle or wrist, especially in the football season.

Sprain can all be treated along the same general lines as a first aid measure. Ideally make the patient as comfortable as possible. If there is obvious deformity, move it as little as possible. Keep it still, and splint it with cotton wool or small cushions or wrapped-up pieces of cloth or clothing. The judicious use of crepe bandages can give support pending taking the patient to medical help. Anything serious should be seen at the emergency ward of a well-equipped hospital as soon as possible. Here X-ray equipment is usually available and on-the-spot diagnosis and treatment may be carried out. If it is more serious, admission to hospital may be considered necessary.

In any accident it is important to be as calm, kind and gentle as possible to the patient. Speak encouraging words; try to allay any anxiety and fears. To a small child these are often of major magnitude. Kind words are very reassuring and can do a lot to help the patient psychologically. Remember how nice it was to have a few kind words spoken by an adult. Never forget it!

Fractures of the Upper Limb

Fractures of the Clavicle

The clavicle is the collarbone, and the arm on the affected side droops. Fractures of the upper limb are painful. Relief will be given if the upper arm is firmly bandaged to the trunk with a wide bandage extending around the trunk. Then the forearm may be supported with a sling. (This may be done with a triangular bandage supporting the forearm and tied around the neck.)

Fractures of the Scapula (Shoulder Blade)

This is treated in a similar manner. Upper part of the upper arm. Apply a collar-and-cuff sling (around the wrist and neck, holding forearm across chest). Wide bandages are then passed around trunk holding the upper part of the arm close to the trunk, thus giving it support. Padding may be placed between the forearm and trunk.

Fractures of the Elbow Joint

Often swelling and pain occur about the injured elbow, and the elbow may not be easily bent. Do not force. If the treatment as outlined is impractical, let the limb remain at the patient’s side (palm inwards) and protect with adequate padding. Make certain the pulse is adequate. Immobilize the limb with wide bandaging around the forearm and upper arm and body.

Fractures of the Forearm and Wrist

Apply a well-padded splint to the front or back of the injured part, extending from the elbow to the wrist. Bandage (preferably with wide bandages) several times, at the level of the hand, also below and above the fracture site.

Fractures of the Hand and Fingers

Support the hand and forearm in a sling (using a triangular bandage). Further support may be given with a wide bandage over the forearm and arm. (Check pulse to make certain circulation is adequate.)

Fractures of the Spine

These may be among the most serious of all, for if nerves emanating from the spinal canal are injured, it may result in paralysis at levels below the injury. The sooner expert help can be gained for these injuries the better. Treat head, neck or spinal injuries as for unconsciousness. Often it is not wise for amateurs to try to handle them, for they may jeopardize the patient’s future. Pain at the site of injury, loss of power or of feeling below the injury indicates that nerves are being affected. Request the patient not to move. Call trained personnel to help, and in the meantime keep the patient warm and comfortable.

Ambulances are now often fitted with special devices for transporting victims such as this to hospital. These injuries are not common, but may occur when diving into shallow water, in motor-vehicle accidents, heavy falls onto the buttock, or falls of earth or rock onto the patient who is stooping.

A child’s bone is generally much more flexible than an adult’s. It is covered with a fairly thick layer of fibrous tissue called periosteum, which contributes to healing if the bone should fracture. At each end of long bones (such as the shinbone) there is an area known as the growth plate, where growth in length and width of the bone takes place. The fastest growing growth plates are the lower end of the femur (thighbone) and the upper end of the tibia (shinbone). Growth plates disappear completely during adolescence.

Fractures

As a child grows, gains weight, and becomes more mobile, falls and other accidents can exert enough stress on a bone to cause a fracture, or break. There are several types of fractures.

Nondisplaced fracture. Sometimes a bone breaks completely but the pieces are not separated. Depending upon the location of the fracture, it will be straightened (if necessary) and then immobilized in a splint or cast for a period of time recommended by the treating physician.

Greenstick fracture. If you have ever taken a fresh branch off a tree and tried to break it, you may have noticed that one side of the branch may break while the other side bends. The same phenomenon can occur in a child’s bone; this is called a greenstick fracture. The treatment is the same as for a nondisplaced fracture.

Displaced fracture. This occurs when the bone breaks completely, and the broken ends move away from one another. This will be treated in one of three ways:

• In a closed reduction, the child is usually sedated or given a general anesthetic, and the doctor then attempts to move the broken pieces into proper alignment. If the procedure is successful, a cast is applied for stabilization until the fracture heals.
• Sometimes the broken ends of the bone can be brought together, but they are so unstable that they will not remain in proper alignment, even with a cast. In such cases metal pins are inserted into the bone to hold the pieces together. This is done under anesthetic, and usually a splint or cast is applied afterward. Depending upon the location of the fracture, the pins will be left in place for a few weeks and then removed.
• If the ends of the fractured bone cannot be brought together by a closed reduction, an open reduction will be performed to accomplish this goal. In this case, the surgeon has to make an incision in the region of the fracture to be able to see the bone ends directly. The alignment is corrected and is often held in place with pins or a plate and screws.

Open fracture. This injury, in which one end of a fractured bone protrudes through the skin, is an urgent situation. The wound should be covered and the child taken immediately to the nearest emergency room. Often, open fractures are contaminated with dirt, grass, clothing, etc. The surgeon will attempt to re-move all of the debris to reduce the chance of infection. Antibiotics should be given. Usually the wound is not sutured together right away, but it may be dosed later if there is no sign of infection.

Sometimes weeks after a child has suffered a fracture, the bone will appear crooked, even though the healing process is going well. Because bone is a living tissue, it not only heals but also undergoes remodeling, a process by which the growth plate and periosteum gradually correct the deformity. If you see an X-ray of the same bone years later, you may find it hard to tell that it was ever broken.

Remodeling cannot correct all deformities, however, and the ability of bones own remodel decreases as a child gets older. If a fracture involves the growth plate, a crooked and/or short limb occasionally results, and surgery may be required to correct this problem.

Sprains

To move properly in relation to each other, the joint between adjacent bones is by strong but flexible fibrous bands called ligaments that help keep the bones proper alignment. A sudden, forceful twisting motion can cause stretching or tears of a ligament, better known as a sprain. This will typically produce pain when a doctor attempts to move or put weight on the affected area, as well as swelling and often a bluish discoloration. Since sprains are more common in adults than in children and since it may be difficult to determine if a fracture is present merely by looking at it as an injured arm or leg, a child with these symptoms should be evaluated by a physician.

The simple acronym RICE can help you remember the steps to take following a sprain:

• Rest the injured area.
• Ice or cold packs can decrease swelling and pain, but their contact with skin should he limited to 20 minutes three to four times a day.
• Compression, such as an elastic wrap around the affected area, can also reduce swelling and pain. (This should not be tight enough to cause discomfort, numbness, or tingling.)
• Elevate the injured area as much as possible for 24 hours to help reduce uncomfortable swelling.

Dislocations

When this happens, the relationship of the two bones that make up a joint is disrupted. In a dislocation of the hip, the ball comes out of the socket. The areas most commonly affected are the shoulder, elbow, kneecap, and fingers. Frequently, there is an associated fracture. Dislocations are best treated by a physician (not by untrained bystanders) and will likely require sedating medication or a general anesthetic to relax surrounding muscles before the bones are put back in their proper relationship. The injured area is usually protected for a few weeks and followed by a gradual return to normal activities. Shoulder and kneecap dislocations often occur repeatedly after the initial episode; sometimes surgery is needed to prevent further episodes. A common dislocation in younger children is the so-called nursemaid’s elbow, which occurs when a toddler or preschooler is tugged forcefully by one arm. Often the injury takes place when an adult is holding the hand of a child who trips while walking. The adult may actually pull upward in an effort to stop the fall. This causes the upper end of the radius (one of two bones in the forearm) to slip through a ring of fibrous tissue that normally holds it in place. Afterwards, the child’s arm may hang limp at his side, and the child will protest loudly if anyone attempts to move it. Often a doctor can resolve this type of dislocation with simple maneuver. Normally this quickly resolves the pain, and soon afterward the child will begin using the arm again.

Tendottitis

Tendons are fibrous tissues that attach muscle to bone. Some tendons, such as those extending to the fingers, are quite long. Repetitive use of certain muscles may cause local inflammation known as tendonitis at or near the attachment site. If your child’s doctor diagnoses this problem, avoidance of activities that provoke pain and possibly the use of anti-inflammatory medications such as ibuprofen may be recommended until the pain resolves.

Bone Fracture First Aid

Some fractures are obvious, and others are suspected when significant pain, swelling, or discoloration follow injury. If you know or suspect that your child has fractured a bone, do the following:

Make sure he avoids putting pressure or weight on it. Gently splint the affected area to reduce pain and the risk of further damage. For an arm injury, a simple sling or a magazine held against the arm with an elastic wrap will usually be adequate. A leg maybe splinted by carefully binding it to the other leg with a towel placed between them.

Don’t try to manipulate fractures or dislocations unless you are trained to do so and you are certain of the nature of the injury. Significant additional injury can occur through inappropriate movement of an injured limb.

• If possible, cover any open wounds to prevent further contamination.
• Don’t give the child anything to eat or drink until the injuries have been evaluated and it is clear that surgery will not be needed.
• Take the child to the nearest emergency department for treatment.
• If the neck appears to be injured it is very important that the child only be moved by people trained to deal with this type of injury. This is an emergency, and assistance should be sought immediately by calling 911. While waiting, keep the child from moving as much as possible. The transport team will carefully apply a neck brace and place the child on spine board.