Fractures, simple

1. FRACTURES/ BONE INJURY
PCC 01/22
BY CAPT D. MAINA
23/02/2022

2. INTRODUCTION
• Fractures are one of the leading cause of death betwwen age 1-37
• Forth cause in all ages
• In KDF, work related environment predisposes members to the injury.
Fractures account for a high percentage of traumatic injuries.
• 60% HEMMORRHAGE
• 33% TENSION PNEUMOTHORAX
• 6% AIRWAY OBSTRUCION, MAXILLOFACIAL TRAUMA

3. AIM
• To acquaint the PCC 01/22 participants with the different types of
fractures and their first aid management

4. Lesson objectives
• By the end of the lesson the participants should be able to
• Identify the different types of fractures
• Describe the signs and symptoms of fractures
• Demonstrate how to manage fractures in the field.

5. Lesson Scope
• Overview of human musculoskeletal system
• Types of fractures
• General principles of fracture management
• Head and spinal injury
• Summary

6. ANATOMY OVERVIEW
• Bones form part of musculoskeletal system
• The human musculoskeletal system consist of the
bony skeleton and muscles.
• The skeleton provides support, protection-brain,
heart lungs- and a movable frame- means of motion.
• The skeletal muscles contraction generates
movement to the skeletal frame.
• The skeleton also provides a pool for calcium,
phosphorus, and is critical in the formation of blood
cells.

8. BONES
• Humans have an endoskeleton that lies within soft
tissues of the body.
• The adult body contains 206 bones.
• Divided into
• Axial skeleton- 80bones. Includes bones of the skull, vertebral
column and thorax.
• Appendicular- 126 bones that includes bones of extremities,
shoulders, pelvis

9. JOINTS
• A joint (articulation) is formed when two bones make
contact with each other. Some joints, such as the knee and
shoulder, allow a good deal of movement. Other joints,
such as the joints of the skull, allow little or no movement.
• The bones of movable joints do not actually touch each
other. They are separated by fibrous tissue that prevents
the bones from rubbing against each other.
• Ligaments, which are composed of very strong fibrous
material, hold the ends of the two bones in place

11. BONE CLASSIFICATION
• According to their shape
• Long bones- Are longer than they are wide. Bones in upper and
lower extermities
Humerus, Radius, Ulna,Femur,Tibia Fibula, metatarsals,
metacarpals and phalanges.
• Short bones- Are cubical. No long axis. Carpals and tarsals
• Flat bones- ribs, cranium,scapula, portions of pelvic girdle.
Protect soft body parts and provide large surface area for
muscle attachment
• Irregular bones- have arious shapes- vertebrae,ear ossicles,
facial bones,pelvis. Are similar to other bones in structure and
composition.

12. BONE GROSS ANATOMY

13. FRACTURES
• Fractures are disruption of the normal continuity of bone.
• The break may only be a crack in the bone (incomplete fracture) or
the bone may be broken into two separate parts (complete fracture).
• Any fracture can be serious. A fracture of a large bone like the femur
can result in a significant loss of blood that, in turn, can result in
hypovolemic shock. Complete fractures are also dangerous because
the sharp ends of the fractured bone can injure muscle tissues,
nerves, and blood vessels. If a rib is fractured in two places, the bone
segment between the two fractures may "float" and damage an organ
(such as the heart or a lung) or a major blood vessel (such as the
aorta).

14. MECHANISM OF INJURY
• ‘Understanding how a person becomes injured helps us determine
what injuries to expect and what treatment to give’
• Gun Shot Wound (GSW)
• Falls
• Road Traffic Collision (RTC)
• Blunt Trauma
• Penetrating Trauma
• Blast

15. Mechanism of injury
• Blast wave
• Blast wind
• Fragmentation
• Pre-formed
• Natural
• crush

16. FRACTURE CAUSES
• Mechanical overload of the bone. More stresss than it can absorb.
• May be direct force to bone – Strike or impact OR
• Indirect force- a powerful muscle contraction pull against a bone.
A fracture can also result from a limb being twisted (fracture and dislocation may result) or from powerful
muscle contractions (such as may occur during a seizure).
Fatigue (stress) fractures can result by repeated stress, such as a stress fracture of the foot during a long march.
• OTHER PREDISPOSING FACTORS
• Biologiacal conditions- osteopenia, osteogenesis imperfect.( Bone brittle, breaks easily).
• Neoplasms- weaken bone,
• Postmenopausal estrogen loss
• Protein malnutrition
• High risk recreation or employment related activities

17. PATHOPHYSIOLOGY
• Severity of a fracture depend on the force that caused the fracture. If
the bone’s breaking point is exceeded only slightly, the bone may
crack rather than break all the way through. If the force is extreme
such as automotive collision or gunshot wound, the bone may
shutter.
• When the bone fractures, muscles attached to the ends are
disrupted. Muscles undergo spasm and pull bone fragments out of
position. Further the periosteum and blood vessels in cortex and
bone marrow are disrupted. Soft tissue damage often occur.
Bleedding occurs from both ends of fractured bone as well as the soft
tissues.

18. Factors affecting bone healing
• Adequate circulation
• Proper fragment immobilization
• Systemic or bone disease
• Fracture type

19. Manifestation of bone injury
• Deformity-
• Swelling
• Bruising
• Pain
• Tenderness
• Loss of function
• Neurological changes- numbness, tingling
senation d/t peripheral nerve damage
•

20. Fracture classification
• Majorly classified as open or closed to the environment
• Open fracture- bone of bone fragments stick out of the skin or a wound penetrates down the
broken bone
• Closed Fracture- has intact skin over the sight of injury
Types of fractures
• By Appearance
• Communate,complete,incomplete,linear, transverse, displaced greenstick

21. TYPES OF FRACTURES
• A fracture may be displaced (bone moved out of normal alignment) or nondisplaced (bone remains in
normal alignment).
• Greenstick. A greenstick fracture is an incomplete fracture in which one side of the bone is broken and the
bone is bent. b. Comminuted. A comminuted fracture is one in which the bone is crushed or splintered into
many pieces. MD0533 1-5 c. Transverse. A transverse fracture is a straight crosswise fracture (break is at a
right angle to the axis of the bone). D
• Oblique. An oblique fracture is a diagonal or slanted fracture (not at a right angle to the axis of the bone).
• Spiral. A spiral fracture coils around the bone and is caused by twisting.
• Impacted. An impacted fracture results when one bone is driven into another bone, resulting in one or both
bones being fractured and the bones being wedged together.
• Pathologic. A pathologic fracture results when a bone that has been weakened by disease breaks under a
force that would not fracture a normal bone. h. Epiphyseal. An epiphyseal fracture is a fracture located
between the expanded end of a long bone (epiphysis) and the shaft of the bone.

23. FRACTURE MANAGEMENT
• C – ACT
• CONTROL
• ASSESS
• COMMUNICATE
• TRIAGE/TRaPS
Primary Survey
<C> CAT/Indirect Pressure/Celox
A Suction Easy/Postural Drainage/Cx
B RIBS- Rate Injury Back Sides (<10 – 30>) *
C “Blood on the Floor and Four More”(Pulse) *
D AVPU ?Pain Relief *
E Burns/Climatic injuries
Pre Evacuation
<C> Still controlled ?
A Still clear and protected ?
B Rate *
C Pulse *
D AVPU *
Handover
A Adult/Child/Male/Female/Age
T Time of Incident
M Mechanism of Injury
I Injury sustained/suspected
S Vital Signs & Symptoms (Rate/Pulse/AVPU)
T Treatment given

24. GENERAL PRINCIPLES OF FRACTURE
MANAGEMENT
• Airway support
• Control of bleeding- catastrophic bleeding? Shock?
• Any potential life threatening injury must be stabilized immediately and
emergency assistance summoned to transport the casualty to a medical
facility
• Priority
• Control bleeding.
• Imobilize the fracture.
• CAUTION:The general principle is "splint the fracture as it lies." Do not
reposition the fracture limb unless it is severely angulated and it is
necessary to straighten the limb so it can be incorporated into the splint. If
needed, straighten the limb with a gentle pull.

25. FRACTURE MANAGEMENT
• Control any external bleeding
• Re-align if possible
• Check distal circulation: If no must go!
• Splint above and below injury and the joints
• Splinting can also be applied following haemorrhage control – it is not
solely for fractures

29. HEAD INJURY
•Causes of lowering of level of
consciousness:
• Blood loss
• Airway and breathing difficulties
• Head injuries
• Climatic injuries
• Basically anything within <C> ABCDE

30. Signs and Symptoms of head injury
• Mechanism of injury
• Trauma to head
• Confused Incoherent
• Dizziness
• Aggressive/Combative
• Nausea and Vomiting
• Unresponsive

31. Head Injury
Treatment
• Dress all wounds and protect the airway
• Any casualty that has a head injury or has
been unresponsive for any length of time
must be evacuated as T1

32. AVPU
Alert
Pain
Voice
Unresponsive
Are they spontaneously
engaging with you?
Are they responding to
you only when you
speak to them?
Are they responding
only when you use
painful stimuli?
Are they not
responding at all?
Note Time and record result
Trapezium / Ear Lobe

33. SUSPECTED SPINAL INJURY
• Any suspected spinal injury should be treated and handled as though
you know has a spinal injury
Signs and symptoms of spinal injury
• Spinal deformity
• Severe head injury
• Pain in the spinal region
• Lacerations(cuts) and contusions(bruises) over the spine
• Numbness or paralysis
• Uncounsciousness

34. IMMOBILIZING A SUSPECTED SPINAL INJURY
a. Apply Manual Traction.
• Immobilize the casualty's head and neck by applying gentle manual
traction.
• (1) Kneel behind the casualty's head, facing the casualty.
• (2) If needed, gently remove the casualty's helmet. CAUTION: Only remove
a helmet if it is necessary to treat an airway problem or interferes with
proper spinal immobilization.
• (3) Place your hands on the sides of the casualty's head with your palms
over the casualty's ears and your fingers supporting the casualty's
mandible (jaw) Pull back slightly to apply gentle traction.
• Maintain the traction until the casualty has been secured to the spine
board.

35. IMMOBILIZING A SUSPECTED SPINAL INJURY
b. Apply Cervical Collar.
• A cervical collar is a rigid device that, when properly placed around
the casualty's neck, prevents the casualty from bending his neck. It
also provides support to the jaw, thus helping to immobilize the
casualty's head. If a cervical collar is available, have your assistant
apply the collar to the casualty's neck.
• If a cervical collar is not available, improvise a collar from material
such as a folded towel, T-shirt, or field jacket. Wrap the material
around the casualty’s neck without moving his head or neck.

36. IMMOBILIZING A SUSPECTED SPINAL INJURY
• c. Place Casualty on Long Spine Board
• Place the board next to and parallel with the casualty
• Secure the casualty’s wrist together at the wrist
• Brief the casualty tht you are goin to move him onto the spine board.
Tell the casualty that should not try to move, the assistants will move
him without any effort on his part
• Position assistants. Have the three assistants kneel on the same side
of the casualty (the side away from the spine board. If one of the
assistants is more experienced than others, place him at the
casualty's chest.

38. IMMOBILIZING A SUSPECTED SPINAL INJURY
• (1) Have the first assistant kneel near the casualty's chest and reach across the
casualty. Have him place one hand at the casualty's far shoulder and the other at
the casualty's waist.
• (2) Have the second assistant kneel near the casualty's hips and reach across the
casualty. Have him place one hand at the casualty's far hip and the other at the
casualty's far thigh.
• (3) Have the third assistant kneel near the casualty's lower legs and reach across
the casualty. Have him place one hand at the casualty's far knee and the other at
the casualty's far ankle.
• Roll Casualty. Upon your command, have the three assistants roll the casualty
slightly toward them in unison. As they roll the casualty, turn his head slightly to
keep it in alignment with his spine.

39. IMMOBILIZING A SUSPECTED SPINAL INJURY
• Slide board into position and position casualty on the board
• Place padding beneath the casualty- Slip padding (folded towels,
jackets, and so forth) at the natural curves beneath the small of the
casualty's back, beneath his knees, and beneath his ankles. Have an
assistant place additional padding beneath the casualty's neck.
• Secure Casualty to Board. Have the assistants secure the casualty to
the long spine board using patient securing straps

40. SUMMARY
• Musculoskeletal system anatomy
• Causes of fractures
• Manifestation of fractures
• Types of fractures
• First aid for fractures
• Evaluate casualty throughout first aid process. Condition may change
• T1 for head and spinal injury
• Splints