A bone fracture is a complete or incomplete break in a bone caused by excessive force. Fractures can be open, where the broken bone pierces the skin, or closed, where the skin is intact. Complicated fractures damage underlying organs. Signs of a fracture include pain, difficulty moving, swelling, deformity, grating sounds, shock, and tenderness near the site. For responsive casualties, fractures should be splinted if possible and the casualty kept comfortable until emergency help arrives. For unresponsive casualties, call for an ambulance and place the casualty in the recovery position while monitoring vital signs until help arrives.