A break in a bone is called a FRACTURE. There are two main types of fractures. A CLOSED FRACTURE is one in which the injury is entirely internal; that is, the bone is broken but there is no break in the skin. An OPEN FRACTURE is one in which there is an open wound in the tissues and skin. This type of break and wound is also referred to as a compound fracture. Sometimes the open wound is made when a sharp end of the broken bone pushes out through the flesh; sometimes it is made by an object, such as a bullet, that penetrates from the outside. Figure 10-48 shows closed and open fractures.

Open fractures are far more serious than closed fractures. They usually involve extensive tissue damage and are likely to become infected. Closed fractures are sometimes converted into open fractures by rough or careless handling of the victim. Therefore, ALWAYS USE EXTREME CARE AND CAUTION WHEN TREATING A SUSPECTED FRACTURE. It is not always easy to recognize a fracture. All fractures, whether closed or open, are likely to cause severe pain or shock but other symptoms may vary considerably. A broken bone sometimes causes the injured part to become deformed or to assume an unnatural position; however, this is not always the case. Pain and swelling may be localized at the fracture site, and there may be a wobbly movement if the bone is broken clear through. It maybe difficult or impossible for the victim to move the injured part. When movement is possible, the victim may feel a grating sensation as the ends of the broken bone rub against each other.

However, when a bone is cracked rather than broken through, the victim may be able to move the injured part without much difficulty. An open fracture is easy to recognize if an end of the broken bone protrudes through the flesh. When the bone does not protrude, you might see the external wound but fail to recognize the broken bone.

When you are required to give first aid to a person who has suffered a fracture, follow these general rules:

1. When there is any possibility that a fracture has been sustained, treat the injury as a fracture.

2. Get the victim to a medical facility at the first opportunity. All fractures require medical treatment.

3. Do not move the victim until the injured part has been splinted, unless you must move out of a life-threatening environment to prevent further injury.

4. Treat for shock.

5. Do not attempt to locate a fracture by grating the ends of the bone together.

6. Do not attempt to set a broken bone.

7. When a long bone in the armor leg is fractured, the limb should be carefully straightened so splints can be applied. Never attempt to straighten the limb by applying force or traction. Pulling gently with your hands in the direction of the long axis of the limb is permissible and may be all that is necessary to get the limb back into position.

8. Apply splints. When the victim must be transported for some distance or when a considerable period of time will elapse before treatment by a medical officer, it maybe better to remove enough of the victim's clothing so you can apply well-padded splints directly to the injured part. However, when the victim is to be transported only a short distance or when treatment by a medical officer will not be delayed, it is probably best to leave the clothing on and apply emergency splinting over it. If you decide to remove the clothing over the injured part, extreme care must be taken. Cut away the clothing or rip it along the seams. Remember, rough handling of the victim may convert a closed fracture into an open fracture, increase the severity of shock and cause extensive damage to the blood vessels, nerves, muscles, and other tissues around the broken bone.

9. When the fracture is open, you must take care of the wound before you can treat the fracture. Bleeding from the wound may be quite serious; however, most bleeding can be stopped by applying direct pressure on the wound or by applying digital pressure at the appropriate pressure point. When these methods are not successful, use a tourniquet. Then treat the fracture. We have now completed the general rules for treating fractures. The symptoms and emergency treatment for fractures for the forearm, upper arm, thigh, lower leg, kneecap, collarbone, rib, nose, jaw, skull, spine, and pelvis are also discussed in this chapter.