Recognising a Suspected Fracture
Not all fractures are obvious, but there are several key signs to look for after an injury. These include severe pain, especially with movement, as well as swelling and bruising at the site. The limb may look bent, twisted, or out of place, a clear sign of deformity.
The person might have difficulty moving the limb, or be unable to put weight on it. Sometimes a snapping or grating sound is heard at the moment of injury. It's important to remember that even if a person can still move the limb, a fracture is still possible; only an X-ray can confirm the diagnosis. If the bone breaks through the skin, it is called an open or compound fracture and requires immediate emergency attention.
The Golden Rule: Stop and Stabilise
The most critical step in fracture first aid is to prevent movement. Any motion can cause the sharp ends of the broken bone to damage nearby nerves, blood vessels, and muscles, potentially turning a simple, closed fracture into a much more complicated injury. Before doing anything else, ensure the scene is safe for both you and the injured person. Then, instruct the person to stay as still as possible and reassure them. Your primary goals are to prevent further injury, reduce pain, and prepare them for professional medical care. Do not attempt to straighten a bent limb or push a protruding bone back into the skin.
How to Immobilise the Injury
If medical help is on the way and the person does not need to be moved, simply supporting the limb with your hands or with soft padding like cushions or rolled clothing is often enough. However, if help is delayed or the person must be moved, you will need to apply a splint. The key rule for splinting is to immobilise the joints both above and below the suspected break. For an improvised splint, find something rigid, such as a rolled-up magazine, a piece of cardboard, a sturdy stick, or a trekking pole. This provides the necessary support.
Applying a Makeshift Splint
First, place generous padding between the rigid support and the injured limb to prevent pressure sores and increase comfort; use towels, clothing, or blankets. Place the rigid support alongside the injured limb, making sure it extends past the joints on either side of the fracture. Secure the splint in place using belts, strips of cloth, or tape, tying it above and below the injury site—never directly over it. The ties should be snug but not so tight that they cut off circulation. Always leave fingers or toes exposed so you can check for swelling, paleness, or numbness, which are signs the splint is too tight.
Manage Pain and Prepare for Help
Once the limb is immobilised, you can take steps to manage pain and swelling. If it is a closed fracture, apply a cold pack wrapped in a cloth to the area for about 20 minutes to help reduce pain and swelling. Do not apply ice directly to the skin. If possible and it doesn't cause more pain, elevate the injured limb above the level of the heart. While waiting for medical assistance, monitor the person for signs of shock, such as feeling faint or having pale, clammy skin. If this occurs, have them lie down, keep them warm, and if possible, raise their legs slightly. Do not give the person anything to eat or drink, as they may need surgery.
When to Call for Emergency Services
You should call for an ambulance immediately if the injury is severe. This includes any open fracture where the bone is visible, heavy bleeding, or a suspected fracture to the head, neck, back, hip, or thigh. If the person is unconscious, not breathing, or the limb below the injury is numb, pale, or cold, it is a medical emergency. For less severe suspected fractures, it may be appropriate to transport the person to an urgent care clinic or hospital, but always call for professional guidance if you are unsure.
