1) Fractures are breaks in bone continuity that can be complete or partial. Types include simple, compound, complicated, and greenstick fractures. 2) Causes include direct force from impacts or falls, indirect force from twisting motions, and diseases weakening bones. 3) Signs are pain, swelling, deformity, inability to move the injured area, and sometimes hearing a snapping sound. 4) First aid aims to prevent further injury, reduce pain, and prepare for medical transport. Injured areas are immobilized using splints or other supports.

1. BY
MR.NAVEED PASHA A
CLINICAL INSRTUCTOR

2. FRACTURES (INJURIES TO BONE)
DEFINITION
Break in the continuity of bone tissue is known as facture/complete or
partial breakage of a bone is known as fracture.
TYPES OF FRACTURES
1. Simple fracture: Also known as closed fracture. Bone is cracked or
broken in two parts but the skin & underneath tissues are intact.
2. Compound or open fracture: Bone is broken and the broken ends
protrude out as the skin & underneath tissues are also cut due to injury.

3. 3 Complicated fracture: In this type of fracture along with bone, an
internal organ may also be injured. Internal organs like brain,
spinal cord, lung, liver, spleen or major blood vessels may get
involved. Complicated fracture can be simple or compound.
4.Greenstick fracture: Greenstick fracture is seen in children below
8 years of age. Bone is not actually broken but it is bent like a green
stick of a tree. This is due to lack of calcium when the bones are
soft.

4. CAUSES OF FRACTURE
 Direct Force. The bone breaks at the impact of force. These direct
forces can be due to bullet passing into the bone, fall from a tree or
high building, fall of heavy object such a sacks full of grains, fall on a
projecting stone or wheel of heavy vehicles passing over the body.
 Indirect Force. Bone breaks away from the spot of application of force
e.g. collar bone fracture when the fall is on outstretched hand,
fracture spine when the fall is one the buttocks region.
 Diseases of Bone. In some cases bones fracture without any force but
due to diseases. Diseases which can affect bones are tuberculosis and
rickets. In old age due to lack of calcium bones get prone to fractures.
This is also called as pathological fracture.

5. SIGN AND SYMPTOMS OF FRACTURE
 Pain at the site fracture.
 Swelling of the area around fracture.
 Tenderness of the fractured site i.e. pain on gentle pressure
over the injured part.
 Inability to move the fractured part.
 Deformity of limb: The limb may loose its normal shape.
Sometimes the muscles pull up the lower ends, resulting in
clear shortening of the limb.

6.  If it is fracture of limb, compare with the sound limb.
 Patient may sometimes say that he heard the snap of bone.
 Clothing may be torn at the fracture site.
 Skin may be bruised or torn at the fractured area.
 If it is a major accident there could be more than one
fracture and other associated injuries.

7. MANAGEMENT
Aims of First Aid in Fractures
 To prevent further damage.
 To reduce pain
 To make the patient feel comfortable.
 To get medical aid/prepare the patient for
transportation.

8. MANAGEMENT
 Look for associated injuries & decide priorities.
 If there is difficulty in breathing artificial respirations
may be required.
 If casualty in shock, treat for shock
 Handle the fractured site very gently, avoiding all
unnecessary movements of the injured part.
 Do not attempt to set the broken ends of bone.

9.  Do not wash the wound or apply any antiseptic lotion if the bone
ends are seen protruding out.
 Immobilization of fractured ends:
 Stabilize and support the injured part immediately so that no
movement is possible. Immobilization stops further injury, and
danger of the broken ends damaging nerves, arteries and muscles is
highly reduced.
 Principle of immobilization is to immobilize the joint above & joint
below the fracture.
 Immobilization can be done with triangular bandages, roller
bandages and sprints or with help of sound limb.
 Support the injured limb on a pillow or cushion.

10. SPLINTS
 Splint is a hard piece of wood, metal or plastic applied to a
fractured limb for support.
 Splints can be improvised with a walking stick, an umbrella, a
broad book, a piece of wood or firmly folded newspapers.
 Splints should be long enough to reach a joint above and a
joint below the fracture.
 Reasonably wider splints are better than narrow ones.
 Splints should be well padded with cotton or cloth so as to fit
softly and snugly on the injured limb.

11. WOUND
 A wound is a break in the skin or mucous membrane
or other body structure, resulting from physical
means. It may be superficial, affecting only the surface
structures or severe involving blood vessels, muscles,
nerves and bones.

12. CLASSIFICATION OF WOUNDS
 Incised wound (surgical wound) is a clean, smooth cut made with a sharp cutting
instrument such as surgical blade or scalpel. It has clean cut edges.
 Abrasive Wound (Abrasion). Is a superficial wound produced by friction or
scraping
 Lacerated Wound (Laceration). Lacerated wound has irregular and torn edges.
These wounds are usually made by animal bites, machinery or jagged objects. These
wounds bleed profusely.
 Contused Wound (Contusion). Is a wound made by blunt instruments or heavy
sacks or boxes falling on the body parts. The surface tissue may or may not be broken.
Bruising of the surface tissues results in extravasation of blood into the skin or
surface tissues results in extravasation bluish discoloration. The swelling resulting
from hemorrhage into the tissues is knows as hematoma.

13.  Punctured wound (Stab wound). Is a wound made with a
pointed object, such as a nail, wire or bullet. It pierces to
deeper tissues, leaving only a small opening on the surface.
These wounds bleed less but are most prone to infection by
tetanus bacilli.
 Penetrating Wound. It occurs as a result of an instruments
passing through skin or mucous membrane to deeper tissues
and entering a body cavity or an organ.
 Perforating Wound. Is caused by an instrument that both
enters and emerges from a body cavity or an organ. A gunshot
wound may be perforating or penetrating wound.

14. COMPLICATIONS OF WOUNDS
 Wound get many complications but two of them are
important i.e. bleeding and infection. Bleeding is the
immediate danger and should be treated immediately.
Normally a wound is not initially infected though it may be
contaminated by dirt, germs and other infected material.
Infection occurs after sometime when the micro-organisms
get time to multiply. This time varies according to the
number of micro-organisms, their virulence and casualty’s
resistance to infection.

15. AIMS OF FIRST AID
 To arrest hemorrhage.
 To prevent the wound getting infected.

16. Arrest Hemorrhage
 Wash hands thoroughly before proceeding to attend on to the wound
 Apply direct pressure to the wound with a sterile dressing if available,
otherwise a clean kerchief or hand towel can be used.
 If any foreign objects are visible and can be removed without further
bleeding, it should be removed else leave it as it is.
 Do not disturb any clot if already set.
 Handle the wound gently and as minimum as possible.
 Do not remove the original dressing, if the wound still bleeds, add
more dressings.

17.  If the wound is on the limb and there is no fracture, raise the limb,
it decreases the bleeding & swelling.
 If necessary press on the arterial pressure points.
 Get the medical aid or transfer the patient to nearest medical
centre.
 Tourniquet. These are tight bands tied around the limbs, always on
a single bone and were often used in the past to prevent bleeding or
arrest spread of snake venous, but they are no longer recommended
because it also restricts the return of venous blood to the heart and
if left in place for more than 15 minutes may cause limb to become
dangerous.

18. Prevention of infection
 Wash hands thoroughly with plenty of clean water and soap.
 Clean the external wound with plenty of potable water.
 Remove any foreign material from the wound, without
disturbing any clot if already formed.
 Do not apply any antiseptic on the wound.
 Cover the wound with sterile dressing if available otherwise
freshly washed and ironed kerchief, hand towel or dupatta can
be used.
 Bandage tightly.

19. HAEMORRHAGE
Is bleeding i.e. running out of blood from blood vessels
and is caused by the rupture of blood vessels due to any
injury.

20. TYPES OF HAEMORRHAGE
Hemorrhage is classified in many ways.
Depending On Blood Vessels Broken
 Arterial Hemorrhage. An artery which carries oxygenated blood is
broken. The blood comes out in jets because it corresponds to the
beats of the heart in action. Blood is bright red in colour.
 Venous hemorrhage. Blood is dark red in colour being
deoxygenated blood and it flow in continuous stream
 Capillary hemorrhage. Blood oozes out from capillaries and is very
slow in flow. If it is on the surface of skin, it is not serious and stops
without any first aid/medical treatment.

21. Depending upon visibility of bleeding
 External or revealed haemorrhage. If it is on the surface of
the body, it is called external bleeding.
 Internal or concealed haemorrhage. It is within the body
cavities and can not be seen immediately, but gradually the
blood pressure drops and pulse rate increases. In some cases
blood may ooze out from nose, ear, mouth or coughed up,
passed in urine depending upon the body organ involved.
Bleeding from special sites. Like bleeding from nose, ear,
eye, in urine, in stool or in vomitus.

22. Signs and Symptoms of Bleeding
 Casualty feels light headedness and may even collapse.
 Casualty is anxious and trembling
 There may be blueness of the lips and paleness of skin.
 Skin is cold and clammy.
 Dryness of the mouth
 Fast pulse.
 Eyesight may feel blurred and concentration poor.
 There is profuse sweating.
 The casualty feels exhausted and may become unconscious.

23. Arrest Hemorrhage
 Wash hands thoroughly before proceeding to attend on to the wound
 Apply direct pressure to the wound with a sterile dressing if available,
otherwise a clean kerchief or hand towel can be used.
 If any foreign objects are visible and can be removed without further
bleeding, it should be removed else leave it as it is.
 Do not disturb any clot if already set.
 Handle the wound gently and as minimum as possible.
 Do not remove the original dressing, if the wound still bleeds, add
more dressings.

24.  If the wound is on the limb and there is no fracture, raise the limb,
it decreases the bleeding & swelling.
 If necessary press on the arterial pressure points.
 Get the medical aid or transfer the patient to nearest medical
centre.
 Tourniquet. These are tight bands tied around the limbs, always on
a single bone and were often used in the past to prevent bleeding or
arrest spread of snake venous, but they are no longer recommended
because it also restricts the return of venous blood to the heart and
if left in place for more than 15 minutes may cause limb to become
dangerous.