First aid - fractures

Bone fractures can be among the most painful injuries which the nurse providing first aid might encounter. Skilled early management of a fracture can have a lasting impact on the outcomes the patient experiences, especially where the fracture is associated with other injuries, e.g. those resulting from trauma.

There are some very basic indications that a casualty has a fracture. These include:

• limited or no movement
• bruising/redness
• changes in sensation
• coldness distal to the fracture, e.g. cold fingers
• other wounds
• bone penetration through the skin, e.g. open fracture

While some signs and symptoms of fracture are common to other forms of injury, e.g. those including soft tissue, in the absence of an X-ray, the nurse should always treat any injury where there is the slightest suspicion as a fracture.

Causes of fractures

The types of fracture nurses providing first aid might encounter are usually those arising from trauma, where the cause is obvious, e.g. a road traffic accident or a fall from height, although fractures also occur as sequelae to other diseases, e.g. pathological fractures associated with osteoporosis (National Institute for Health and Care Excellence, 2018) or as a result of localised stresses, e.g. stress fractures due to over exercising (Robinson et al, 2019).

Some fractures are associated with dislocations, e.g. of the elbow. In the first aid setting, dislocation should be treated in the same manner as a fracture. 

As with all first aid, the priority for the nurse treating a person with a suspected fracture is the management of concomitant injury or illness which may be life threatening, e.g. loss of consciousness with the need for airway management (see first aid - loss of consciousness) or severe bleeding (see: first aid- managing bleeding).

While shock is a common sequelae of fractures, it is important not to elevate legs to treat it where there is a suspicion of a leg fracture or injury to the pelvis or lower spine (St John Ambulance, 2021). That said, where the person is in a life-threatening situation or where not moving them may contribute to a threat to life, e.g. managing their airway (See: managing an airway and choking), or prevent lifesaving treatment, e.g. the commencement of cardiopulmonary resuscitation (See: first aid - CPR), managing the more dangerous illness or injury

References

National Institute for Health and Care Excellence.  es Impact: falls and fragility fractures. 2018.  https://www.nice.org.uk/media/default/about/what-we-do/into-practice/measuring-uptake/nice-impact-falls-and-fragility-fractures.pdf (accessed 06 May  2022).

NHS. Overview: First aid. 2022.  https://www.nhs.uk/conditions/first-aid/ (accessed 06 May  2022)

Perkins GD, Grasner J-T, Semeraro F et al. European Resuscitation Council Guidelines 2021: Executive Summary. Resuscitation. 161:1-60. https://doi.org/10.1016/j.resuscitation.2021.02.003

Robinson PG, Campbell VBD, Murray AD et al. Stress fractures: diagnosis and management in the primary care setting. Br J Gen Practice. 2019; 69(681):209-300. https://doi.org/10.3399/bjgp19X702137.

St John’s Ambulance. Fractures (broken bones). 2021.  https://www.sja.org.uk/get-advice/first-aid-advice/bones-and-muscle-injuries/broken-bones-and-fractures/?category=12283 (accessed 06 May 2022).

Zideman DA, De Buck EDJ, Singletary EM et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid. Resuscitation. 95:278-287. https://doi.org/10.1016/j.resuscitation.2015.07.031