Fracture
Fracture, by definition, means break.1 However, there are different types of fractures that are commonly encountered (see Figure 1).
Simple (closed) fracture-The bone is fractured, but there is no significant deformity of the bone, and it has not broken the skin. The majority of fractures you'll encounter fall into this category.
Compound (open) fracture-The bone is fractured, with breaking/laceration of the skin. Bone may or may not show from the wound.
Transverse fracture-The fracture is across the bone, and at a right angle to its long axis.
Greenstick fracture-This type of fracture is named after the breaking of a green tree branch. One side of the bone is fractured, while the other side is only bent. These types of fractures occur commonly in children, as their bones aren't as brittle as adults'.
Comminuted fracture-This is a fracture involving three or more bone fragments.2
Signs & Symptoms
There are various signs and symptoms that can be exhibited by patients with fractures. It's often obvious to the patient, either from sound, feeling or both, that there's been a fracture, and they will let you know: "I heard a snap."
Signs and symptoms include deformity, discoloration, crepitus (a cracking, grating or scraping type noise made when bone ends rub together), tenderness, swelling, inability to move the affected extremity, pain when moving the affected extremity, bleeding and/or bone protrusion.3 If nerve, muscle or vessel compromise exists, then numbness, tingling and loss of sensation and/or pulses may be encountered.
If a significant amount of blood is lost, either through a wound or internally, the patient may exhibit signs and symptoms of shock. Obviously, there are situations where it is impossible to truly determine if a fracture exists in the prehospital setting. If you are unsure whether a fracture exists, treat the patient as if it does.
