3 Fractures and Limb Injuries

Recognize possible injuries

A Fracture is a break, crack, or chip in a bone. Other limb injuries include a Sprain, which injures a ligament; a Strain, which injures a muscle or tendon; and a Dislocation, in which bones are displaced at a joint.

These injuries can look alike. Treat a painful muscle, bone, or joint injury as a possible fracture rather than trying to diagnose it.

Notice signs and warning changes

Possible signs of a limb injury include pain, tenderness, swelling, bruising, difficulty or inability to use the limb, or an unusual shape. A person may still be able to move the limb or bear weight even with a fracture, so movement or weight-bearing does not rule one out.

Numbness, tingling, unusual paleness or blueness, or cold skin beyond the injury can signal a serious problem. An Open fracture breaks the skin, although bone may or may not be visible.

Prioritize safety and emergency help

1. Check the scene and the person. Use appropriate personal protective equipment and get consent when possible. Check for immediate threats to life, such as unresponsiveness, breathing problems, or severe bleeding, and address those first within your training.

2. Call 911 for serious warning signs. These include an open fracture, obvious deformity, severe bleeding, numbness or color change below the injury, suspected injury to the hip or pelvis, or multiple injuries. If you are unsure, call for emergency advice. Keep the person still and reassured while help is coming.

Treat any painful limb injury as a possible fracture, even when it is not visibly deformed. The aim is to protect the person and limit further movement until help or medical assessment is available.

Support the limb and manage wounds

Ask the person not to use the injured limb. Support it gently in the position found, using your hands, pillows, folded clothing, or a blanket. Do not pull, straighten, or push a bone or joint back into place. Do not test movement or ask the person to walk on an injured limb.

For an open wound, cover it with a clean or sterile dressing. If it is bleeding, apply pressure to the wound while avoiding pressure on any protruding bone. Do not probe the wound or push exposed bone back in. For life-threatening bleeding, call 911 and use bleeding-control measures you are trained and equipped to provide.

For a closed injury, a cold pack wrapped in cloth may help with pain and swelling. Do not place ice directly on the skin or let the pack cause additional pain.

Know when support or movement is limited

A lay first aider generally should not apply a rigid splint. If you are trained to splint and a splint is needed to move the person or medical help is delayed, support the limb in the position found, pad the splint, and avoid making pain or circulation worse. A sling may support an injured arm if it is comfortable and does not require moving the injury.

Do not move someone with a possible head, neck, back, hip, or pelvic injury unless there is immediate danger or movement is necessary to provide lifesaving care.

Monitor the person until help arrives

Keep checking the person’s breathing, responsiveness, and injured area. Notice whether the hand or foot beyond the injury becomes colder, paler or bluer, numb, or tingly, and report any change to emergency responders. Keep the person comfortably warm.

After a fall, for example, a swollen and painful wrist should be treated as a possible fracture even if the person can move their fingers. Stop them from using the wrist, support it as found, check for changes in finger color or sensation, and arrange medical assessment. Call 911 if the wrist is visibly deformed, the fingers become cold or numb, or other serious injuries are present.