Injuries to bones and joints

The bones and joints of the skeleton, and the muscles that move them, are more than strong enough to carry out the movements, and withstand the forces, we subject them to in normal daily life. Sprains, dislocations and fractures may result, however, if the bones and joints come into contact with excessive force, as can happen in falls, traffic accidents and sporting injuries. The kind of injury depends on the direction and force of the blow.

Sprains

A sprain occurs when the ligaments around a joint are stretched too much. The joint becomes painful to move, swollen and tender; these symptoms also occur with a fracture, so if you are in any doubt about the severity of the injury, you should give first aid as for fractures and refer the casualty to hospital. If the sprain is only mild the immediate aim should be to reduce swelling. The joint needs to be cooled and elevated if possible. In the case of the ankle, the most commonly strained joint, prop the leg up comfortably on cushions or a chair. A cold compress can be im-provized out of a bag of crushed or cubed ice that is then applied to the joint; if ice is not available, a packet of frozen peas or cloths wrung out in cold water will do. If the pain and swelling are severe, or get worse, seek medical advice.

Dislocations

A dislocated joint is one in which the bones have been displaced from their normal position. The shoulders and jaw are the most commonly affected joints. Symptoms – pain on movement, swelling and tenderness – are again similar to those found with a fracture, and should be treated in the same way. The displacement of the limb or joint may also be obvious, but no attempt should be made to move the dislocated bone back into its normal position: you will probably only cause further damage. Instead, minimize the casualty’s discomfort by immobilizing the joint. In the case of a dislocated shoulder, for example, this can be achieved by tying a sling around the neck. The weight of the arm in the sling keeps the joint stable.

Fractures

A bone may fracture or break as a result of a direct force; or it may break because of a blow received some distance away. When someone puts out his hands to save himself in a fall, for example, the force is transmitted up the outstretched arm and may cause the collarbone to snap.

Fractures may be open (that is, associated with a surface wound) or closed (the skin is not broken above the fracture). You may be able to see the broken ends of the bone protruding from an open fracture. Even if the fracture is closed, blood vessels within and around the bone are usually damaged. Particularly in fractures of the femur, a large amount of blood may be lost into the surrounding tissues. As with a sprain, the area around a fracture becomes swollen and tender, but pain is much more severe. The casualty may have heard the bone snap or felt something giving way. It may be obvious from its abnormal position that the limb or body part is damaged. Any internal bleeding that occurs in a closed fracture will cause bruising around the fracture. With open fractures, there is a risk that the wound may become infected. When treating a fracture your first priority should be to stop bleeding and to cover the wound to prevent bacteria entering. Pressure over the fracture will be extremely painful, so try to stop the bleeding by pressing the edges of the wound together. Once you have achieved this, cover the wound with a sterile gauze dressing and then build up a ring pad with either a twisted bandage or layers of cotton wool. This should be held firmly in position with a bandage, taking care not to put too much pressure on the fracture.

With both open and closed fractures, the injured person should not be moved unless medical help is unavailable or danger threatens. Inexpert movement may worsen the damage. Provided medical help is on its way, the most sensible thing to do is to support the injured part in its existing position, so that the casualty is as comfortable as possible.-If the person needs to be moved before medical help arrives, the fractured part needs to be immobilized so that further damage is prevented. A fractured arm should be placed in a sling tied around the neck. If the leg is fractured, move the uninjured leg so that it is next to the injured one, place soft padding between them and tie several bandages around both legs. The bandages should be knotted on the uninjured leg. Another possibility is to tie the injured leg to a wooden board, immobilizing the joints and bones adjacent to the fractured bone. Never tie the bandages so tight that they cut off the circulation to the extremities, causing numbness or tingling. Check regularly that the fingertips or toes are pink and not white or blue, and that a pulse can be felt in the limb.

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