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Any broken bone is a significant injury requiring immediate medical attention. In most instances, we make our way to the hospital emergency room or call 911 for an ambulance. That makes sense and is usually motivated by the extreme pain that the victim is obviously experiencing.
It’s a good bet that many of us have suffered a broken bone at least once in our life. Some of us may have endured it more than once. The hardest time is when a young child approaches us crying and in pain while holding their arm with their other hand. How many of us can forget that nerve-wracking drive to the ER when everyone seems to be driving too slow?
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Where There is No Hospital
It seems unreasonable to think of a situation when professional medical care is inaccessible, but it happens all the time. Many hikers, mountain climbers and others engaged in outdoor activities are confronted with a broken bone in a remote wilderness area where medical attention is distant and hard to reach.
In areas affected by catastrophic disasters, local medical facilities are either overwhelmed by more serious injuries or have simply been destroyed by the cataclysm.
It’s also a sad fact that in many countries, the general level of medical care is limited or non-existent. If for any reason you happen to be in those countries when you or someone in your group or family suffers a broken bone, you may be on your own.
Finally, there’s the combination of extreme events that can create a perfect storm for disaster. In some parts of the world, areas have been confronted by out of control wildfires compounded by heavy rains and flooding all occurring in the midst of a global pandemic. Add the ominous threat of wars and civil unrest occurring in some countries today, and medical options and availability become a luxury.
Broken Bones 101
We will try to consistently use and link to credible medical advice for the treatment of any bone break from sources like The Mayo Clinic, FEMA, The Harvard University Medical School, and the NIH. Regardless of the quality of the advice, the severity of any broken bone is difficult to assess without an X-ray or at the very least, the qualified expertise of an orthopedic medical specialist.
If at all possible, find some way to get medical attention. If it is simply impossible, you’ll need to take matters into your own hands. Unless of course one of your hands is broken. Here are some basic things to know and fundamental treatments for broken bones.
10 Types of Fractures
It’s tempting to believe that all broken bones are the same, but the complexity of events that can lead to a bone fracture create breaks of varying levels of severity. Here are the 10 types of fractures according to orthopedic specialists:
1. Transverse Fracture
Transverse fractures are breaks that are in a straight line across the bone. This type of fracture may be caused by traumatic events like falls or automobile accidents.
2. Oblique Fracture
An oblique fracture is when the break is diagonal across the bone. This kind of fracture occurs most often in long bones. Oblique fractures may be the result of a sharp blow that comes from an angle due to a fall or other trauma.
3. Spiral Fracture
As the name suggests, this is a kind of fracture that spirals around the bone. Spiral fractures occur in long bones in the body, usually in the femur, tibia, or fibula in the legs. However, they can occur in the long bones of the arms. Spiral fractures are caused by twisting injuries sustained during sports, during a physical attack, or in an accident.
4. Greenstick Fracture
This is a partial fracture that occurs mostly in children. It’s called a greenstick because the bones are still green and growing. The bone bends and breaks but does not separate into two separate pieces. Children are most likely to experience this type of fracture because their bones are softer and more flexible.
5. Stress Fracture
Stress fractures are also called hairline fractures. This type of fracture looks like a crack and can be difficult to diagnose with a regular X-ray. Stress fractures are often caused by repetitive motions such as running.
6. Compression Fracture
When bones are crushed, it is called a compression fracture. The broken bone will be wider and flatter in appearance than it was before the injury. Compression fractures occur most often in the spine and can cause your vertebrae to collapse. A type of bone loss called osteoporosis is the most common cause of compression fractures.
7. Impacted Fracture
An impacted fracture occurs when the broken ends of the bone are driven together. The pieces are jammed together by the force of the injury that caused the fracture.
8. Segmental Fracture
The same bone is fractured in two places, leaving a “floating” segment of bone between the two breaks. These fractures usually occur in long bones such as those in the legs. This type of bone fracture may take longer to heal or cause complications.
9. Comminuted Fracture
A comminuted fracture is one in which the bone is broken into 3 or more pieces. There are also bone fragments present at the fracture site. These types of bone fractures occur when there is a high-impact trauma, such as an automobile accident.
10. Avulsion Fracture
An avulsion fracture occurs when a fragment is pulled off the bone by a tendon or ligament. These types of bone fractures are more common in children than adults. Sometimes a child’s ligaments can pull hard enough to cause a growth plate to fracture.
It’s unreasonable to ask anyone to commit this level of orthopedic complexity to memory, but the important point to remember is that not all bone breaks are the same. That’s why it’s so important to ask the fundamental question, “What happened?’ Understanding the events that cause the potential bone break can give you an idea of the type of fracture and some thoughts on basic treatment.
An Historical Perspective
Long before hospitals and the development of orthopedic medical science, people were suffering broken bones for as long humanity has walked the Earth. Archeological excavations have unearthed the remains of many people who have shown healed bone breaks.
Significantly, some people were buried with various types of splints and wound dressings still intact and with the bones unhealed. That assumption was that the injured person was treated and ultimately died as a result of the trauma or the onset of infection.
What’s significant is that many of the ancient treatments are still used today, specifically splints, wraps, and topical treatments to reduce inflammation and pain.
A Modern Perspective
There is a good amount of basic first aid advice for treating a broken bone. Most of it is short term and to provide immediate treatment to prepare someone for a trip to the hospital or while waiting for paramedics to arrive. But in a situation without medical expertise, these treatments will have to not only provide immediate relief, but continuing treatments and care will have to be determined.
According to the Mayo Clinic, there are some preliminary steps that can and should be taken with most bone fractures:
- Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
- Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in. If you've been trained in how to splint and professional help isn't readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.
- Apply ice packs to limit swelling and help relieve pain. Don't apply ice directly to the skin. Wrap the ice in a towel, piece of cloth, or some other material.
- Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.
- If you suspect a bone is broken in the neck, head or back. Don't move the person except if necessary to avoid further injury. Do everything possible to find some level of professional medical expertise to deal with this level of injury.
That’s good advice, but it presents some ominous possibilities for anyone trying to treat a fracture without professional medical assistance. It’s beyond the scope of an article to define ways to treat someone for a broken neck, back or a fractured skull.
There are books written on the subject that offer some level of advice, but any severe fracture requiring surgery or other advanced medical treatments are beyond the scope of what most people can do. For that reason, the following information is for simpler fractures that only require immobilization for healing and various treatments for swelling and pain.
Compound fractures where the bone break is exposed and has penetrated and punctured the skin is another complicated situation where the only course of non-professional medical treatment is to stop and manage bleeding, immobilize the affected limb, prevent infection and, to the best degree possible, pain.
We’re going to cover basics for short-term first aid treatment of a fracture and then consider long-term treatments to allow healing to occur.
Basic Fracture First-Aid – Short Term
According to WebMD, some basic treatments for a fracture in a wilderness environment or other remote location includes:
1. Stop Bleeding, if Necessary
- Apply firm pressure to wound with clean cloth until bleeding stops.
- If bone is pushing through skin, do not touch it or try to put it back in place.
2. Splint the Area, if Possible
The purpose of the splint is to hold still and protect a wounded body part from further damage.
- Cut away clothing if it cannot be removed without moving the injured body part.
- Gently tape the dislocated area or fracture to a rolled-up newspaper, ruler, stick, or a rolled-up piece of clothing with first aid tape. You can also use a splint from a trauma level first aid kit. In general, try to include the joint above and below the injury in the splint. As much as possible, avoid moving the injured limb, and never force it or try to twist it back into place.
3. Reduce Swelling and Prevent Injury
- Apply an ice pack wrapped in cloth or a cold compress.
- Elevate the injured area if possible.
4. Manage Pain and Inflammation
- For pain, give ibuprofen (Advil, Motrin), acetaminophen (Tylenol), or naproxen (Aleve, Naprosyn). Do not give aspirin to anyone under age 18.
Basic Fracture First-Aid – Long Term
Bone fractures typically heal over the course of 6 to 8 weeks, although some breaks like a tibia fracture can take 20 weeks. A lot depends on the location and severity of the fracture. There are fundamental steps to take to aid and assist someone in the process of healing from a bone fracture. Here are the key steps to consider.
Healing time for fractures are divided into three phases:
1. Inflammatory Phase: Starts at the time of injury and lasts 1-2 weeks. Bleeding around the fracture organizes into a fracture hematoma or clot on the bone ends. Damage to the tissues results in cell death which is cleaned up by an inflammatory response. The blood clot organizes into a protein mesh where the bone begins to “knit”.
2. Repair Phase: Lasting the next 2-3 weeks where actual tissue repair occurs and new living cells of bone, cartilage and fibrous tissue occur at the fracture site. This leads to the formation of a rubbery tissue called “fracture callus”. Calcium is deposited into the callus and can be seen on x-ray at 2-3 weeks after injury.
3. Remodeling: Occurs as the fracture callus is replaced with strong organized bone. Remodeling goes on for months after the fracture is no longer painful and appears to be healed on x-rays.
How can you help or speed fracture healing?
1. Activity: Some fractures may require early activity and weight bearing to speed fracture healing. Others need to be immobilized and avoid weight bearing. Muscle use in the injured limb helps blood flow, reduces swelling, and speeds exchange of nutrients to damaged tissues. It also helps to reduce stiffness and muscle atrophy (shrinkage).
2. Nutrition: Maintain a well-balanced diet. Protein, Vitamins C, D, and K are all essential for fracture healing. Calcium, Magnesium, Phosphorus and Zinc are all elements needed for bone formation and to accelerate the healing process.
3. Smoking: If you smoke, STOP. This is probably the greatest single thing you can do to help fracture healing. Smoking inhibits fine capillary blood flow that is essential to healing.
4. Avoid high dose Nonsteroidal Anti-Inflammatory medicines such as ibuprofen or naproxen. These medications can inhibit the early phase of fracture healing.
A Bone Fracture First Aid Kit
Most basic first aid kits offer few if any supplies for treating many broken bones. You usually have to purchase an expedition level, trauma first aid kit to find the necessary supplies. However, you could assemble your own. Here’s a basic list of items used to treat a range of fractures:
- Splints
- Slings
- Trauma bandages
- Gauze rolled bandages
- Elastic ACE bandages
- Pads and padding
- Wrist braces (for both left and right hand)
- Ankle braces
- Knee braces
- Leg brace/splint
- Back braces
- Cervical collar
- Finger splints
- Medical tape
- Tourniquet
If you have children you might want to also investigate children’s sized braces for wrists and ankles, although most of the standard supplies can be customized to fit any size body or limb.
Finding Medical Expertise in Desperate Times
Usually, various local, state and federal emergency services are in the area of any disaster. They’re often overwhelmed, but for critical injuries like a bone fracture, you may be able to at least find someone somewhere to assist.
If Internet service is still available, there are medical consultations that you can do online. Some are video conference capable so they can both listen to and observe symptoms and injuries and offer advice on how to treat something like a fracture even if you or they are inaccessible in person.
This is a Worst Case Scenario
Some injuries are beyond the scope of home first aid treatments, but when things are at their worst, you have to do your best. Take the time to at least read some of the linked articles and resources and think about having some detailed medical books on hand along with a well stocked first aid kit.
Fractures are unfortunately common, and if you have a good working knowledge of how to deal with a medical emergency like a broken bone, you can at least offer some reassurance that things will eventually be better.
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