A bone fracture or broken bone occurs when there is a partial or complete disruption in the continuity of bone tissues. A bone fracture can occur in any part of the body, including the skull and spinal vertebrae, and anyone can suffer from a fracture, whether they are children or elderly. Fractures in the bone can result from accidents, overuse, violent abuse, falls, sports injuries, and weakened bone due to diseases.

There are several different types of fracture, mainly are:

Closed or simple fracture: In this type, broken bones do not impact the surrounding tissues, and the skin remains intact.
Open and compound fracture: In an open fracture, the broken bones can injure the surrounding tissues and skin and has a visible wound.
Compression fracture: The crush or compression fracture occurs in spongy bones, mainly in osteoporosis-affected vertebrae.
Comminuted fracture: A fractured bone consists of three or more fragments, and these pieces remain at the fracture site only.
Segmental fracture: Fracture of the same bone in two places results in a floating piece of bone.
Hairline fracture: A thin, partial fracture without any bone fragment dislocation is a hairline fracture.

Most people with a bone fracture or dislocation may experience severe pain, swelling, unable to move or pay weight on the affected area, protrusion at an unusual angle, and sometimes bleeding from the open wound. Although bone fractures are not life-threatening, they require immediate attention. Call to emergency helpline number if you notice major trauma or injury. Sometimes, it will take time to reach paramedics, or the wound may require immediate management, administer first aid for fracture until help reaches out.

First aid management of fractures

If you suspect a bone fracture in your loved ones or anyone near you, do not panic. Recognize the symptoms of fracture, administer first aid for fracture, and get healthcare professional help. First aid treatment for a fracture is crucial for better recovery and pain management till the paramedic reaches out.
Let us understand the step-by-step first aid for fracture management, including what to do or not to do. The following are the what-to-do fracture first aid steps:

Control bleeding, if any:

It is the first step of first aid treatment for the fracture. In case of an open fracture, if you notice bleeding from the wound, try not to manipulate the visible protruding bone and only take care of the bleeding. Cover the injured area with a sterile gauge or a clean cotton cloth. Use mild constant pressure only around the wound and not over the protruding bone to control the bleeding until help comes. You can also secure the dressing with a bandage to further support the injured area. Controlling the bleeding without disturbing protruding bone fragments is the primary fracture first aid step.
You should administer CPR if the person is not responding or has breathing difficulty.

Immobilize the fractured area:

Temporary immobilization after a fracture or dislocation can improve comfort, reduce soft tissue swelling, and protect open wounds from infection. If there is a simple fracture or dislocation, encourage them to support their area by holding it or supporting by cushion or pillow.
Temporary immobilization with splints, slings, or bandages for fracture management is the foremost crucial step of first aid treatment for the fracture. Keep in mind while bandaging the fracture area that not tries to align the fracture segments, as it may cause further damage.

Cold pack application:

Apply an ice pack or ice cubes wrapped in a clean cloth at the injured site minimum of ten minutes. Ice packs help reduce inflammation, swelling, and pain by numbing the injured area. It also reduces bleeding by constricting blood vessels at the affected site.

Manage shock:

Immediately after a fracture, people may experience shock or uneasiness. Try to reassure them and help them get into a more comfortable position. Sometimes, bleeding and severe trauma may induce hemorrhagic shock. Monitor their pulse and breathing, try to control bleeding, and raise the patient's leg, if possible, to manage shock.

Elevate the injured part:

If possible, elevate the injured area above the heart level. But if the fracture area causes discomfort, do not elevate it.

Get help:

If the bone fracture does not involve an open or complicated wound, take them to the emergency department for proper bone fracture treatment. Call the emergency helpline or ambulance service if the injury is severe and may worsen with mobility.

Knowledge of the above step-by-step first aid for fracture management helps you in the long run in case you or your loved ones encounter bone fracture or dislocation.

The following are the what not to do bone fracture first aid steps:

Do not move the injured person unless there are chances of further fall and damage.
If there are any out-of-place bones, do not attempt to realign them.
Avoid touching or washing the open wound, as it increases the risk of infection.
Do not apply the bandage too tight.
Avoid feeding or giving drinks to the injured patient as they may need surgery later, and food particles may interfere in the process.

The appropriate first aid management of fractures can give a better outcome in bone fracture treatment.

What are the stages of fracture healing?

The healing of bones is a complex, regenerative process that is of two types:

Primary or direct healing: The bony fragments fuse by compression in direct healing. Bones require an anatomical reduction. There is no formation of the callus during healing.
Secondary or indirect healing; Secondary healing is more common in bone fractures. In this type of healing, bone fragments have a small gap, which causes callus formation and secondary bone formation.

Most bone fracture healing follows secondary healing. The following are the stages of bone healing:

Hematoma formation

Rupture of the blood vessels supplying the bone and periosteum forms a hematoma around the fracture site within minutes. Hematoma clot forms the temporary fabricate for subsequent bone formation. This stage lasts for 1-5 days after fracture.

Many inflammatory cytokines are released from the damaged bone area, stimulating various cells and vascular endothelial growth factor (VEGF) to stimulate healing and remove necrotic tissues.

Callus formation

This stage of bone healing is of two types:

Fibrocartilaginous callus formation: Blood capillaries start growing from hematoma clots, and numerous cells appear, such as phagocytes, osteoblasts, and fibroblasts. These cells clear away the dead cells and form fibrocartilaginous calluses between the broken ends. This stage of fracture healing lasts for 5-11 days.
Bony callus formation: After some days, the fibrocartilaginous callus starts undergoing endochondral ossification and converts into a bony callous spongy bone.

Bone remodeling

In this stage, osteoclasts and osteoblasts remodel the bony callus, removing excess material within the medullary cavity and bone exteriors and adding compact bone tissues. The bone remodeling may take a few months to create bone tissues similar to the unbroken bone.

What is the treatment for fracture?

The main goal of first aid for fractures is to control bleeding, remove foreign bodies, and prevent ischemic bone injury. After bone fracture first aid, the next step in the treatment of the fractures is the reduction (setting of the fractured bone fragments) and maintenance of the fracture.

The setting of the fracture bone fragments or reduction is of two types:

Closed reduction: Repositioning of fracture bone without surgery
Open reduction: Repositioning using surgery

Maintenance of fracture reduction with immobilization technique can be of the following types:

Non-operative methods: These includes:
- Casts, splints, and bandages for fracture immobilization are the most common non-operative immobilization methods.
- Traction, either by skin traction or skeletal traction
Surgical methods: Healthcare specialists can use two types of surgical reduction immobilization:
- Open reduction and internal fixation (ORIF): The surgeon uses various internal fixation devices, such as Kirschner wires, screws and plates, and intramedullary nails.
- External fixation: In this procedure, the specialists stabilize the fracture at a distance from the injured site.

Narayana Health group of hospitals has the best orthopedic doctors in India, implying the best possible treatment options and managing complicated fractures.

Conclusion

The main objective of first aid for fractures is to manage blood loss and prevent injury from getting worse. The doctor suggests everyone have knowledge of step-by-step first aid for fracture, which includes stoppage of bleeding, temporary immobilization, ice pack application, and elevation of the fracture area if possible. First aid for fractures aid in better recovery, protect the unconscious person, and prevent complications.

Dr. Dickey Richard Marak, Orthopaedics & Joint Replacement Surgeon, Narayana Superspeciality Hospital, Guwahati