FRACTURE, DISLOCATION, SPRAIN AND STRAIN

 Fractures, Dislocations, and Sprains

 Fractures

A fracture is defined as a break in the continuity of a bone.

 Causes of Fractures

 1. Direct Violence: The bone breaks at the exact site where the force is applied (e.g., a car wheel passing over a leg).

 2. Indirect Violence: The bone breaks at a distance from the site of impact (e.g., falling on an outstretched hand resulting in a broken clavicle).

 3. Muscular Violence: A sudden, violent contraction of a muscle snaps the bone (e.g., a strong contraction of the quadriceps causing the patella to fracture).

 Predisposing Factors

  Age: Extremes of age (very young or very old) make bones more susceptible to breaking with minimal force.

  Disease: Conditions like Osteomyelitis, Rickets, Tuberculosis, or Bone Cancer weaken the bone structure.

 Classification and Varieties of Fractures

1. Simple (Closed) Fracture: The bone is broken, but there is no wound leading from the skin to the fracture site.

2. Compound (Open) Fracture: The skin is broken, allowing for communication between the bone and the exterior. This carries a high risk of infection.

 Specific Types of Fracture

1. Greenstick: Common in children; the bone bends and breaks only on one side (like a green twig).

2. Comminuted: The bone is crushed or splintered into several fragments.

3. Impacted: The broken ends are driven into one another and wedged tight.

4. Complicated: The broken bone causes damage to internal organs (e.g., a broken rib piercing a lung).

5. Depressed: Typically occurs in the skull, where a fragment of bone is forced inward.

 Signs, Symptoms, and Repair

  1. Pain: Severe pain at the site, worsened by movement.

 2. Tenderness: The area is painful to the touch.

 3. Swelling and Bruising: Caused by internal bleeding and tissue damage.

 4. Loss of Function: Inability to use the affected limb.

 5. Deformity: The limb may appear shortened or at an unnatural angle.

 6. Crepitus: A grating sensation felt or heard when the broken ends rub together.

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 IV. First-Aid Management

 Aims of Treatment

  To prevent a simple fracture from becoming a compound one.

  To immobilize the part and arrange quick transportation to the hospital.

 General Principles

 1. Position: Keep the patient lying down and still.

 2. Stop Hemorrhage: Address obvious bleeding immediately with clean dressings.

 3. Treat for Shock: Keep the patient warm and calm.

 4. Immobilization (Splinting):

    Body Splinting: Tying an injured leg to the uninjured leg or an arm to the trunk.

    Mechanical Splinting: Using external supports (walking sticks, umbrellas, branches, or folded cardboard).

    Rule of Splinting: Splints should be long enough to extend above and below the joints adjacent to the fracture. They should be padded to prevent direct pressure.

Dislocations, Sprains, and Strains

Dislocations: Occurs when bones forming a joint become displaced.

 Signs: Deformity of the joint, loss of power, and intense pain.

Treatment: Immobilize the joint in its current position using a sling or bandages. Never attempt to "pop" the bone back into place; transport to a hospital immediately.

Sprains and Strains

Sprain: Forcible wrenching of a joint, involving stretching or tearing of ligaments.

Strain: Over-stretching of a muscle or tendon.

Management: Treat as a fracture until proven otherwise. Apply cold compresses to reduce swelling and provide firm support with bandages.


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