• Simple and hairline
  Fractures occur when the bone breaks but does not protrude or damage skin and surrounding tissue.
• In open or compound
  Fractures, there is a wound leading to the site of the fracture. Bone may protrude from the wound.

Sub-categories of fracture include comminuted, where the bone is shattered into pieces, and impacted, in which one bone is pressed into another.

Neck and spine fractures are particularly serious because of the risk of permanent paralysis due to spinal cord damage.

First Aid Guide for Fractures
Procedures to follow:
1. Check for vital signs pulse and breathing. If these are absent, begin cardio-pulmonary resuscitation CPR and call an ambulance or doctor.

2. Watch for signs of shock weakness; cold, clammy skin; rapid, shallow breathing; faint pulse; nausea and possible vomiting; fainting or loss of consciousness. Keep the casually lying down, warm and calm until medical help arrives.

3. Place a clean cloth or hand if a cloth is not available over the wound and apply gentle pressure. If any bone is protruding, build up pads of material around the bone until you can bandage over the top of the wound.

4. Do not move the casualty. If you must, to avoid further injury, make sure the injured part is immobilized. This is especially important if you suspect a fracture of the spine.

5. Do not give food or fluids because this could cause a delay in giving a general anaesthetic.

6. Do not let the casualty attempt to ‘try out’ an arm, leg or other suspected broken bone until the casualty has been examined by a doctor.

Supporting a fracture
If a broken arm or leg is suspected,the limb should be immobilized to help pervent further injury; and also to help relieve pain.

If an ambulance is likely to arrive within 30 minutes, the casualty can be immobilized using pillows to bolster the injury. In the case of lower limb injuries, if removal to hospital is likely to be delayed by more than 30 minutes, a splint should be used.

The injured part can be steadied with your hands until a more secure from of support is provided.

Upper limb injuries, in which the elbow can be bent, may be supported with a sling. If the casualty is capable of holding the broken arm across the chest, ask them to do so. Place soft padding over the arm, and hold the arm in place with a sling.

If the arm cannot be bent, place soft padding between the injured arm and the body, and then secure the limb with three broad bandages, one around the upper wrist and hips, one around the forearm and trunk, and one around the upper arm and upper trunk.

For lower limb injuries, place padding material such as clothing, a sheet or a blanket between the two limbs, and use bandages to secure the injured leg to the uninjured leg.

If a fractured leg is bent or angled so that you cannot immobilize it you may need to apply traction by pulling steadily in the line of the bone. Stop applying traction if it is causing intolerable pain.

Slings and bandages should be tied snugly but not so tight as to constrict blood flow. Check the fingers or toes of the injured limb every 10 minutes to ensure that the circulation is not being cut off.

First aid for neck and spinal fractures
Any accident that places excessive force or pressure on the neck or back can result in fracture. An injury to the spinal cord in the neck can result in total paralysis from the point of injury down. If the injury takes place in the lower back, the arms and upper body will retain movement but the lower part of the body will not.

If you suspect a neck or spinal injury follow these procedures:
1. Check for vital signs pulse and breathing. If they are absent, begin CPR.
2. Call for an ambulance or emergency doctor.
3. Do not move the casualty until the neck and back are immobilized. Even if the person is in a painful or awkward position, keep the casualty still until help from someone experienced in moving accident victims is available. See box below.
4. To stabilize the head and neck in the position in which the person is lying, slide a rolled pad under the neck and then place stabilizting objects like pads or books at the top and sides of the head to keep it from moving.

A casualty may be anxious to test whether he she can move. Reassure the person but do not let them move. If necessary, have several people restrain the casualty until help arrives.

SYMPTOMS
These might include:

• Swelling.
• Pain and tenderness.
• Deformity or misalignment of the injured part.
• Inability to use the injured part.
• Protrusion of bone through the skin.

IMPORTANT
Apply gentle traction as you straighten a limb. If this is painful, stop at once.

If a ‘sprain’ is swollen and painful for several days, see a doctor. Often, fractures can be detected only by x-ray.

WARNING
Do not attempt to move an accident victim with a suspected broken bone unless it is absolutely necessary. If the person must be moved to avoid further serious injury: for example, from a burning building or car, quickly immobilize the limb and get the victim onto a firm object that can serve as a stretcher. Or you can place him or her on a blanket and carefully drag the blanket, but not the person.