Closed bone fractures, like open ones, are very common in adults and children. They arise both from a fall and during mechanical action. The most common is a fracture of the limbs, much less often – the ribs, forearm and pelvis. Any of them can become life-threatening, so experts advise knowing how to provide first aid for closed fractures.
What is a closed fracture, causes, signs of a closed fracture, classification of the injury and much more should be known before providing first aid.
Cause of fracture
Injuries of this kind arise from both external and internal factors. They can also be complex.
- Bone fractures can occur when a person falls, both from the height of his height, and from a large one.
- From a strong blow with a heavy, blunt object.
- A compression fracture of a vertebra can be triggered by heavy lifting.
- A broken limb can be obtained during a street fight.
- car accident.
- Industrial or sports injury.
- Fractures received from being under the rubble.
- Musculoskeletal disease or osteoporosis.
- tuberculosis of the bones.
- Bone neoplasm.
- Metastasis to bone.
- Diseases of chronic etymology.
- Thin bone tissue after surgery.
- Genetic pathology or Lobstein’s disease – Vrolik.
- Bone cyst.
Also, the closed form of the fracture is divided into indirect and direct mechanism of bone fracture.
The first is when the fracture occurs at a location far removed from the point of impact.
The second involves bone deformity in the impact zone.
Abnormal bone fractures can occur with minor impact – if an elderly person rolls over from side to side in bed. Children most often suffer from a periosteal or subosseous fracture – for example, the collarbone. In babies, epiphysiolysis also occurs – or the separation of bone fragments in the growth zone.
What types of closed fractures of limb bones are known? Focusing on the severity of damage, fractures are divided into complete and incomplete. With incomplete damage to the bone, there are:
With a complete fracture, the bone is displaced from its natural location.
Depending on the location of the bone fragments, fractures are divided into:
- with an offset – the edges of a broken bone are located incorrectly relative to their original position;
- without displacement – the position of the bone fragments has not changed after the injury.
Depending on the nature of the damage, the following types of fractures are noted:
- Longitudinal – the fracture runs parallel to the bone axis.
- Transverse – the defect is directed perpendicular to the axis of the bone.
- Oblique – the fracture line is located at different angles relative to the bone.
- Comminuted – consists of several fragments of bone.
- Wedge-shaped – due to the penetration of bone fragments one into the other. Occurs with spinal fractures.
- Spiral – the fracture resembles a spiral.
- Impacted – with fractures of tubular bones, fragments fall into each other.
- Compression – does not have a fracture line, is characterized by the appearance of small fragments, and the length of the bone is significantly reduced.
Depending on the location of the fracture, they are of the following types:
- Diaphyseal – a fracture in the area of \u200b\u200bthe bone body.
- Metaphyseal – the defect is located between the diaphysis and the epiphysis.
- Epiphyseal – a fracture at the location of the head of the bone.
Any fracture can have serious consequences or be accompanied by the following pathologies – blood poisoning, bleeding, fat embolism and pain shock. With such anomalies, a closed injury will be considered severe, and medical treatment will require additional measures.
Symptoms and signs of a closed fracture
Signs of a closed fracture of the bone experts divide into relative and absolute. With absolute signs, additional diagnostics are not required. Relative signs are not enough to accurately state a closed fracture.
Relative signs are the following symptoms:
- Pain increases with any movement.
- Severe pain at the time of injury.
- A sign of a fracture is the formation of edema in the area of injury within 30 minutes.
- In the tissues surrounding the fracture, hemorrhages appear, turning into hematomas.
- The injured limb or body part partially or completely loses mobility.
An absolute sign can be considered:
- On movement or palpation, there is an obvious crunch or crepitus.
- The limb begins to move abnormally.
- One of the symptoms of a fracture is limb deformity.
With a closed injury of the extremities, the main symptoms indicating the presence of this injury are the following indicators:
- When moving, loading or at the time of probing, the pain syndrome at the site of injury increases.
- The injured place is severely deformed – if the legs and arms are broken, then they lengthen and change shape, with an injury in another place, bulging of the bones is observed.
- Motor activity is significantly reduced – a patient with fractures can hardly perform the usual functions, and with severe fractures, the victim cannot move at all.
- Hematomas – internal bleeding manifests itself in the form of a bruise or hematoma.
- Edema appears in the damaged area – this happens due to problems in the functioning of the lymphatic system and local microcirculation.
- Hemarthrosis – occurs after injury to the joints, ligaments.
- Crepitus – damaged bone during movement produces a characteristic sound in the form of a crunch.
Now that you know most of the main signs of this fracture, you can familiarize yourself with what to do with a closed fracture.
Help with a closed fracture
Knowing what first aid is needed for such injuries, you can significantly alleviate the condition of the victim.
First aid is based on a specially developed algorithm. Therefore, when starting to provide assistance, it is necessary to strictly follow the prescription.
First aid for a closed fracture:
- First aid must begin with the treatment of an open wound in order to avoid infection. To do this, you need to treat it with an antiseptic and apply a sterile bandage.
- To provide assistance, it is necessary to perform the main action – to fix the damaged part of the body or limb. It is necessary to find a material for the manufacture of a special tire. The base material should be something solid that can secure the injured limb or body part so that it remains immobile. To do this, it is necessary to fix the movable joints above and below the injury site. If everything was done correctly during first aid, then the patient will be transported successfully, otherwise the victim will experience severe pain.
- The injury site should be cooled – apply ice to the injury, replacing it if necessary. The cold helps reduce pain and swelling.
- When providing assistance, it must be borne in mind that the patient may experience severe pain. Therefore, you should find analgesics, both in tablets and in injections, which can be injected just above or below the injury. It is strongly not recommended to give alcohol to the victim in order to “anesthetize”. Such a measure will only destroy bone cells, and further healing will be very difficult.
- Having provided first aid, it is necessary to organize the transportation of the victim to the hospital for the treatment of closed fractures. If it is not possible to call a medical team, then you should build a stretcher yourself or find transport to deliver the victim to the tram station, where he will be provided with a medical service.
- When assisted by others, one of the participants should always be near the victim, in case it is necessary to stop a memory attack and prevent him from moving or getting up.
There are also a number of rules that should be observed when helping people with closed fractures.
- When fixing the limb with a splint, the position of the victim should be comfortable and natural.
- With a fracture of the hip or spine, you can not move the patient on your own.
- When providing first aid, alcohol is not allowed. Stress will not help to relieve, but can lead to disability and death.
- When assisting, it is not allowed to fold bone fragments on their own.
Remember! In no case should you panic when helping the victim. You should do everything you know before the ambulance arrives. In case of ignorance, it is better not to take risks.
Diagnostics and therapy
There are several methods for determining a closed fracture. After the first medical aid has been provided, the doctor collects the patient’s history, this is necessary to find out the cause of the injury and its nature. Next comes palpation – thanks to this method, the traumatologist determines the presence of bone fragments and whether there is a displacement.
To make an accurate diagnosis, x-rays are prescribed in two projections. After the specialist examines the images and confirms the diagnosis, the necessary therapy will be prescribed.
For complex fractures, diagnostic tools such as CT, arthroscopy, and ultrasound are used.
Treatment of closed fractures begins with the provision of PMP. After that, the doctor prescribes treatment. The main treatments consist of:
- conservative therapy.
- Surgical intervention.
Which method the traumatologist will use in the treatment of a closed fracture depends on which bone was broken.
If the medical indications of the victim indicate that the bone injury is of mild severity without displacement or the patient is not allowed to undergo surgery, then conservative treatment is used for therapy. With this method, the bone is repositioned, followed by fixation. The procedure is performed using local anesthesia.
After the reposition has been completed, plaster and other special fixing bandages are applied to the damaged area. With a comminuted fracture, skeletal traction is used. The duration of therapy is controlled by a doctor.
The operational method is more efficient. This treatment method is preferred for severe fractures, when it is necessary to use special means to fix the bones.
The basis of surgical intervention is that metal objects are introduced into the bone fragments – knitting needles, pins, plates, screws, nails.
Some patients are prescribed bone grafting and arthroplasty. In order for the bones to grow together well, stimulation with anabolic hormones, mummy and an electromagnetic field is used.
Important! Bones grow together over a period of several weeks to a couple of months. This process depends on the severity of the fracture and the age of the patient and a number of existing pathologies.
Do not delay with the diagnosis and treatment of the disease!
The bone skeleton is the basis for the performance of motor functions. It easily copes with the permissible load, but with serious injuries, its strength is significantly reduced. In such cases, a fracture of one or more bone elements occurs. What is the difference between injuries, and how to provide first aid for fractures?
Type and symptoms of fractures
They adhere to a detailed classification, with the help of which the traumatologist chooses further treatment.
By violation of the structure:
- oblique line;
- with a chip;
- spiral or screw;
- in two or more places.
Due to occurrence:
- traumatic (in case of a sharp blow, fall, accident);
- pathological (chronic impairment of calcium synthesis and absorption, bone fragility, osteoporosis).
By severity of injury:
- open (the bone passes through the tissues to the outside, accompanied by hemorrhage into the muscles, large vessels are often affected);
- closed (there is a bone injury without affecting the nervous, vascular and muscle tissues).
- displacement (the bone goes to the side after a reflex contraction of the muscle);
- there is no displacement (there is a fracture in the bone, but it is located along the axis).
By degree of damage:
- complete (separation of the bone occurs in two or more places);
- incomplete (a chip or crack is observed in the bone);
- green branch (the bone is broken from the inside or side, the outer layer is not damaged).
You can determine the damage to the bone yourself. In case of injury, the symptoms are felt acutely, causing significant discomfort. Early treatment, even with a severe fracture, can prevent many complications.
- Limbs, other parts of the body move easily in areas where there are no joints.
- The fracture site takes on an unnatural appearance due to ruptures of muscles, bone elements and ligaments.
- With any attempt to move, a characteristic crunch or crepitus is heard. It is well heard through a phonendoscope.
- With open types of fracture, bone elements are visible on the surface of the skin, and there is a high probability of bleeding from the artery.
- Loss of consciousness in patients on the background of traumatic shock.
- Severe pain attacks from any load, in a calm state.
- Extensive or minor edema (also occurs with bone bruises, sprains, dislocations).
- Hematomas. Appear from blood clotting under the top layer of the skin.
First aid for closed fractures
Closed damage carries fewer complications than the open type. But in this case, help should be provided on time.
- It is necessary to treat the area of injury with an antiseptic agent in case of superficial skin rupture or abrasions. This will stop the infection from getting worse.
- People around use improvised means to make a fixing splint. Use any solid object – a board, a strong stick.
First aid for open fractures
Open injuries are dangerous due to rupture of blood vessels. There is a high probability of tissue death and large blood loss before the arrival of paramedics and transportation of the victim to the hospital.
After processing and fixing the limb, a tight tourniquet or hemostatic bandage is applied. It is done with the help of things, a rope, a bandage or a belt.
Before applying a tight bandage, determine the nature of bleeding. Venous blood has an intense red color, evenly oozing from the wound. When the arteries are damaged, bright scarlet pulsating blood is observed. The tourniquet is fixed under the wound if a rupture of the veins has occurred. After stopping the blood loss before the arrival of the paramedics, the tourniquet is periodically weakened so that the tissues do not undergo death.
For first aid for fractures of the jaw, it is advisable to use a sling bandage. The device is a reliable fixator of the mandibular joint, and prevents squeezing and destruction of the facial bones.
Preliminarily, with the help of tampons, excess blood is soaked from damage to the maxillary artery. The patient’s mouth is cleaned if there are blood clots and fluid left. The tongue is wrapped with a bandage when it sinks. For a closed jaw injury, the use of a cold compress is allowed.
Great care is taken when removing loose teeth. You can not touch the living fragments of bones that are associated with the periosteum. To alleviate the condition from pain shock, it is permissible to inject Baralgin. The patient is urgently taken to traumatology, a jaw fracture threatens health and life.
Pre-medical first aid for bone fractures in the chest area is provided in order to prevent complications – perforation of the aorta, compression and displacement of the heart or lungs. The most difficult to recognize the closed damage in this area. What symptoms to look out for:
- Sharp prickly pain behind the sternum, aggravated by sneezing, exhaling and coughing.
- Breathing is difficult, the victim is anxious.
- Respiratory movements of the chest become asymmetrical.
- Soft tissues swell, bruises appear on the body.
- If the lung tissue is damaged, the patient coughs up blood.
- Severe pain and blood loss leads to loss of consciousness, the skin turns pale, the heart rate quickens.
The first medical aid for fractures of the ribs include bandaging the sternum on exhalation. This will reduce the likelihood of bone displacement during breathing movements. For better fixation, one of the limbs of the victim is pressed against the body and securely fastened.
The patient is transported in a sitting or reclining position. If the injury is one-sided, it is allowed to turn the body to the affected side.
Bone damage in this area is the most dangerous for human health. Violation of the vertebrae often leads to disability or complete immobilization. A comminuted fracture increases the risk of spinal cord injury with further neurological abnormalities. The patient needs to provide emergency care for a fracture of the spine, otherwise, his condition will end in death.
Transporting the patient is prohibited until the arrival of the resuscitation machine. They do not allow head turns, fixing the neck with thick cardboard and rope. The victim is tied to a hard surface of a wide board, door or plywood. The limbs are tightly tied to each other, a roller of clothes is placed under the lower back. It is necessary to immediately inject a person with an anesthetic. If cardiac arrest is detected, cardiopulmonary resuscitation is used.
In order not to damage other bones and not aggravate the fracture of the spine, chest compression is carried out through a blanket.
What to do with fractures of the upper limbs?
Hand injuries in trauma practice are the most common type of fractures. With possible damage to the bones, the patient is given an anesthetic and a thorough examination is carried out. With a closed fracture of the upper limb, immobilization is important. If you do not immobilize it in time, the bones will quickly shift and damage the soft tissues. A splint is placed on the arm and tightened to complete immobility. It is forbidden to pull the brush or set the bone yourself. With open damage, the tourniquet is tightened a few centimeters higher from the damaged area. The open wound is washed with hydrogen peroxide, and the edges are treated with an antiseptic.
The most fragile place in the hand is the hand, and it breaks quite often in the elderly and children. Injury can damage the metacarpal bones, wrist, phalanges of the fingers, or palm. Rings are removed from the victim, since with edema they can provoke tissue necrosis. Be sure to apply an ice pack or other cold object. A tight bandage is applied when bleeding so that the arm remains in a bent position. Fixation with a bandage is carried out over the shoulder. First aid for a fracture of the hand should be done quickly. Complications can lead to complete immobilization of the hand.
Fractures of the lower extremities
The rules for first aid for leg fractures are identical for violations of the bones of the hands. The patient is calmed, anesthetized and the leg is firmly fixed. If there are no solid objects nearby, one limb is tied to the other so that the patient does not have the opportunity to move. The victim is transported with minimal load and with complete immobilization of the leg to avoid rupture of blood vessels. Until the hemorrhage is eliminated, the splint is not applied.
What to do with a clavicle fracture?
From a fall or other injury, a clavicular fracture can occur, and the first aid in this case is the complete immobilization of the body. The limb is pressed tightly to the damaged side and tied, a tissue roller is placed under the arm. If the patient is not taken to the hospital quickly, the dressing is adjusted every 30-40 minutes to make it tighter.
Ligation for clavicular fracture
Eight. A quick and effective way to bandage a patient so that the bones do not move. A bandage is tied at chest level, dense rollers are applied near the shoulder blades. The bandage is passed along the back, on the chest, covers part of the back and is passed through the recess under the armpit. With the help of a tight dressing, the shoulders are set in a natural position.
What should be the help to the child?
Children’s bones are not yet as strong as those of an adult. They are quite flexible and often break like a green branch – on one side, the fabrics remain intact. This greatly simplifies the fusion of bones and muscles.
The child can be very frightened of pain and injury, so he must be immediately calmed down and given painkillers. For any type of fracture, the injured child is immediately taken to the hospital, after applying a tight fixing bandage.
To avoid fractures, it is necessary to maintain a healthy lifestyle. Alcohol and cigarettes contribute to the rapid destruction of bone tissue. The lack of elementary physical exercises leads to stagnant processes in the musculoskeletal system. To reduce the load on the bones, it is recommended to maintain optimal body weight. Nutrition should be balanced, contain the necessary set of elements.
Editor: Oleg Markelov
Rescuer of the Main Directorate of the Ministry of Emergency Situations of Russia for the Krasnodar Territory
A fracture is a lesion in which the integrity of the bone is broken. Depending on the nature of such a lesion, an open and closed fracture is determined, first aid for each of which implies the provision of actions of various specifics. Today we will focus on the first aid provided for a closed fracture.
The difference between a closed and an open fracture is determined by the name itself, that is, an open fracture implies a lesion in which the integrity of the skin in the fracture area is violated, while a closed fracture excludes such an outcome, that is, the skin is not damaged.
Signs of fractures
- sharp pain in the affected area;
- deformation of the affected limb, its visual shortening;
- swelling in the affected area;
- detection of abnormal mobility of the bone (or bones) in the affected area;
- general impairment of the functionality of the affected limb.
It should be noted that open fractures are much more dangerous than closed fractures, because their peculiarity lies in the infection of bone fragments, in addition to this, damage to nerves, muscles, and blood vessels is also possible. In addition to this, the possibility of heavy bleeding, a state of shock in the victim is not excluded.
First aid for a closed fracture
- Stop bleeding.
Even closed fractures are accompanied by damage to the skin, therefore, if abrasions, wounds or bleeding appear, appropriate treatment should be carried out by applying a tourniquet or a sterile pressure bandage.
- The imposition of a fixing bandage on the limb (tires).
The imposition of such a bandage is designed to ensure the immobility of the limb during a fracture and, accordingly, immobility for bone fragments. Immobility must also be ensured in the joints located below the fracture and above it (the same applies to dislocation). If we are talking about a fracture of the shoulder or hip, a triple capture of the joints is performed. If this condition is not met, the victim during the transportation process will experience more pronounced manifestations of traumatic shock due to pain, which, in turn, can lead to death. The tire can be any of the materials at hand.
As a rule, any type of damage to a joint or bone is accompanied by a condition such as traumatic shock, the severity of its manifestations may be different. Accordingly, this requires the use of any anesthetic drug, which includes analgin.
- Delivery of the patient to the emergency room or calling an ambulance.
Closed Fracture: Basic Precautions
First aid for a closed fracture is extremely important for the victim, but some precautions should also be taken into account when providing it. Let’s note them below.
Splinting of the damaged area requires preliminary giving it a normal physiological position.