Recognise the Signs of a Fracture
It can be hard to tell the difference between a fracture, a sprain, or a bad bruise without an X-ray. However, there are common signs that point to a broken bone. Look for intense pain, especially when the area is touched or moved. You might see significant
swelling, bruising, or an obvious deformity, where a limb looks bent at an unnatural angle. The person may have been unable to move the limb or put weight on it. Sometimes, a snapping or grinding sound is heard at the moment of injury. If you suspect a fracture, it's always best to treat it as one until a doctor can make a diagnosis.
Prioritise Safety and Control Bleeding
Before doing anything, ensure the area is safe for both you and the injured person. Then, your first priority is to address any life-threatening issues. If there is heavy bleeding, that needs to be controlled immediately. For an open fracture, where bone is protruding through the skin, do not try to wash the wound or push the bone back in. Cover the wound with a clean, sterile cloth and apply firm pressure around the wound, not directly on the exposed bone, to stop the bleeding.
Immobilise the Injured Area
The most important principle of fracture first aid is to keep the injured part still to prevent further damage to bones, nerves, or blood vessels. Do not try to straighten or realign the limb. Your goal is to support the injury in the position you found it. You can use cushions, pillows, or rolled-up clothing to support the limb on either side. If professional medical help is delayed or you need to move the person, you may need to apply a splint. You can improvise using a rigid object like a rolled-up magazine, a ruler, or a piece of cardboard, making sure to pad it well. The splint should extend beyond the joints above and below the break and be tied securely, but not so tightly that it cuts off circulation.
Manage Pain and Swelling
Once the limb is stable, you can help manage pain and swelling. Apply a cold compress, like an ice pack or a bag of frozen vegetables wrapped in a cloth, to the area. Never place ice directly on the skin. Apply the cold pack for 15 to 20 minutes at a time. If possible and without causing more pain, elevating the injured limb above the level of the heart can also help reduce swelling. For an arm, this might mean resting it on a pillow across the chest; for a leg, propping it up on cushions. Avoid giving the person food or drink, as they may require anaesthesia for treatment later.
Watch for and Treat Shock
A serious injury like a fracture can cause the person to go into medical shock, a life-threatening condition where the body isn't getting enough blood flow. Signs of shock include pale, cold, or clammy skin; a rapid, weak pulse; and fast, shallow breathing. The person may feel faint, dizzy, or confused. If you suspect shock, have the person lie down. Keep them warm with a blanket or jacket. If possible, and if there are no suspected injuries to the legs, hips, or spine, you can elevate their legs slightly, about 12 inches, to improve blood flow to their vital organs. Do not elevate their head.
