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There are 206 bones in the human body. The skeleton holds our skin up, and bones act as factories for producing blood and essential blood cells through bone marrow. Bones are also integral to the body’s strength.

Some bones have a protective function (skull), some a supporting function (pelvis), while others are for movement (fingers).

When a bone is broken, or fractured, it affects not only blood production and function, but there can be complications associated with the muscles, tendons, nerves and blood vessels that are attached, or are close, to the bone.

Fractures are generally classified as:

Openwhere there is a wound exposing the fracture site, or the bone is protruding from the skin. Closedwhere the bone has fractured but has no obvious external wound. Complicatedwhich may involve damage to associated vital organs and major blood vessels as a result of the fracture.

Immobilisation is the preferred way to manage fractured limbs as it helps reduce movement and the pain associated with fractures. Immobilise the limb with a natural splint, such as another part of the body, improvised splints, cardboard, wooden or air splints.


Fractures may be caused a number of ways:

• Direct force; where sufficient force is applied to cause the bone to fracture at the point of impact.
• Indirect force; where force or kinetic energy, applied to a large, strong bone, is transmitted up the limb, causing the weakest bones to fracture.
• Spontaneous or spasm-induced; where fractures are associated with disease and/or muscular spasms.

These are usually associated with the elderly, and people with specific diseases affecting the bones.
Always exercise care when assessing an elderly casualty as the condition known as osteoporosis or ‘Chalky Bones’ causes bones to fracture easily, often in several places. Always suspect a fracture if an elderly person complains of pain or loss of power to a limb.

Be especially aware of fractures at the neck of the femur (near the hip), a very common fracture in the elderly.

Young children are also prone to fractures. Arm and wrist fractures are common with children. As young bones do not harden for some years, children’s fractures tend to ‘bend and splinter’, similar to a broken branch on a tree – hence the common name ‘greenstick fracture’.



Some, or all of the following:

• pale, cool, clammy skin
• rapid, weak pulse
• pain at the site
• tenderness
• loss of power to limb
• associated wound and blood loss
• associated organ damage
• nausea
• deformity

Signs and symptoms of fractures relies on immobilising and adequately splinting the injury. If the fracture is particularly complex, the wound associated with an open fracture maybe difficult to control.

If the pulse further down the limb cannot be restored by gentle and careful adjustment of the limb or with minor traction, the limb should be stabilised where it is.

Do not spend time attempting to splint instead of calling for urgent ambulance transport.

Circulation must be checked after a splint or sling has been applied. If the limb swells this will make the bandages tighter and this may cause circulation problems.

Indications that a bandage may be too tight include:

• Absent pulse below the bandage
• Pale/blue appearance below the bandage
• Lack of warmth below the bandage
• Pain
• Swelling
• Tingling or loss of feeling in fingers or toes

Generally, fractured limbs should be kept immobile until medical assistance arrives. However, in remote areas or where it is some time from medical aid, you may be required to treat as follows:

Fractured Arm/Collar Bone

• check for warmth or pulse to the hand, if no circulation:
  • if possible, gently and carefully adjust the position of the limb until pulse returns
• treat any wounds
• pad bony prominences
• apply adequate splint
• secure splint above and below fracture
• reassess pulse or return of colour/warmth after splint applied
• apply appropriate sling (see page 73)
• fractured lower arm
  • apply arm sling
• fractured upper arm
  • apply collar and cuff sling
• fractured collar bone
  • apply elevated sling
• reassess pulse or return of colour/warmth after sling applied
• adjust bandages or sling if required

Fractured Leg

• check for warmth or pulse to the foot, if no circulation:
  • if possible, gently and carefully adjust the position of the limb until pulse returns
• treat any wounds
• immobilise the limb
• pad bony prominences
• reassess circulation below injury
• adjust bandages if required

Fractured Pelvis

• call ‘000’ for an ambulance
• check for pulses in both legs
• bend legs at knees, elevate lower legs slightly and support on pillows or similar
• support both hips with folded blankets either side
• discourage attempts to urinate
• adjust bandages if required

Care must be exercised with a suspected fractured pelvis. This injury may have serious complications. The casualty should always be transported by ambulance and not by alternative means unless absolutely essential.

Fractured Jaw A common injury in certain contact sports is dislocation, or fracture, of the lower jaw (mandible). The casualty will have pain in the jaw, be unable to speak properly, and may have trouble swallowing.

• call ‘000’ for an ambulance
• 4 support the jaw
  • sit the casualty leaning slightly forward
  • rest the injured jaw on a pad held by the casualty
• DO NOT apply a bandage to support the jaw.

Observe the casualty carefully for signs of breathing difficulties and any indication they are becoming drowsy or unconscious.

Dislocations Dislocations involve the displacement of bone from a joint. These injuries are often underestimated, and can have serious consequences in the form of damage to nerves and blood vessels. Many people have joints which dislocate easily due to a congenital condition, or weak ligaments, stretched by previous repeated dislocations.

• sudden pain in the affected joint
• loss of power and movement
• deformity and swelling of the joint
• tenderness
• may have some temporary paralysis of the injured limb

• RICE (see page 75)
• support limb in position of comfort
• seek medical aid
• any attempt to reduce a dislocation is only to be made by a doctor

Slings Use slings to support an injured arm, or to supplement treatment for another injury such as fractured ribs. Generally, the most effective sling is made with a triangular bandage. Every first aid kit, no matter how small, should have at least one of these bandages as essential items.

Although triangular bandages are preferable, any material, eg tie, belt, or piece of thick twine or rope, can be used in an emergency. If no likely material is at hand, an injured arm can be adequately supported by inserting it inside the casualty’s shirt or blouse. Similarly, a safety pin applied to a sleeve and secured to clothing on the chest may suffice.

There are essentially three types of sling; the arm sling for injuries to the forearm, the elevated sling for injuries to the shoulder, and the ‘collar-and-cuff’ or clove hitch for injuries to the upper arm and as supplementary support to fractured ribs.

After applying any sling, always check the circulation to the limb by feeling for the pulse at the wrist, or squeezing a fingernail and observing for change of colour in the nail bed.

All slings must be in a position that is comfortable for the casualty. Never force an arm into the ‘right position’.

Arm Sling

• Support the injured forearm approximately parallel to the ground with the wrist slightly higher than the elbow
• Place an opened triangular bandage between the body and the arm, with its apex towards the elbow
• Extend the upper point of the bandage over the shoulder on the uninjured side
• Bring the lower point up over the arm, across the shoulder on the injured side to join the upper point and tie firmly with a reef knot
• Ensure the elbow is secured by folding the excess bandage over the elbow and securing with a safety pin
  
  
  

Elevated Sling

• Support the casualty’s arm with the elbow beside the body and the hand extended towards the uninjured shoulder
• Place an opened triangular bandage over the forearm and hand, with the apex towards the elbow
• Extend the upper point of the bandage over the uninjured shoulder
• Tuck the lower part of the bandage under the injured arm, bring it under the elbow and around the back and extend the lower point up to meet the upper point at the shoulder
• Tie firmly with a reef knot
• Secure the elbow by folding the excess material and applying a safety pin, then ensure that the sling is tucked under the arm giving firm support

‘Collar-And-Cuff’

• allow the elbow to hang naturally at the side and place the hand extended towards the shoulder on the uninjured side
• using a narrow fold triangular bandage, form a clove hitch by forming two loops – one towards you, one away from you
• put the loops together by sliding your hands under the loops and closing with a “clapping” motion.
• If you are experienced at forming a clove hitch, then apply a clove hitch directly on the wrist, but take care not to move the injured arm
• slide the clove hitch over the hand and gently pull it firmly to secure the wrist
• extend the points of the bandage to either side of the neck and tie firmly with a reef knot
• allow the arm to hang comfortably. Should further support be required, eg for support to fractured ribs, apply triangular bandages around the body and upper arm to hold the arm firmly against the chest