Fractures, dislocations, sprains, and strains -
Physicians call broken bones fractures. Fractures result whenever a bone is hit by enough force to make it break, creating either a small crack or, in a serious fracture, a complete break. Dislocations occur when the bone has slipped out of its normal position in a joint where two bones meet. Sprains occur when the ligaments in a joint are damaged. For example, a sudden twisting of the knee or elbow causes this type of injury, which ranges from over-stretching and small tears to a complete parting of a ligament. Strains - also called muscle pulls - are the most common and usually the mildest of the three injuries. Overworking or overextending muscles, doing heavy exercise during cold weather, and even failing to drink enough fluids can lead to small tears that make using muscles painful. Torn, severed, or irritated tendons the tissues that connect muscles to bones , are very common.
Fractures - There are two basic types of fractures, open and closed. The open fracture - also called a compound fracture - is generally more serious because in this type bone has broken through the skin. The break causes considerable damage to surrounding tissue and can cause serious bleeding if a large artery is broken. It also exposes the broken bone to the possibility of infection, which can interfere with healing. A closed fracture may be either a crack in the bone or a complete break, but in either case the skin is not broken. Often the surrounding tissue is undamaged, especially when the bone is only cracked. But even though bone does not break the skin, it can cause serious internal damage. A skull fracture that causes pressure on the brain or a broken rib that pierces a lung can be life-threatening without prompt medical treatment. Bones that tend to get broken include those of the collar, foot, leg, hand, wrist, and arm. The elderly break bones more easily than younger people because their bones become weaker and more brittle with age - in severe cases this tendency becomes the disorder osteoporosis. A broken hip resulting from a fall is fairly common among older people, especially those with osteoporosis. Though some minor fractures can be hard to detect without an X ray, the symptom most usually noticed is severe pain. The injured area will probably swell, and in complete breaks, an arm or leg may look deformed. See your doctor immediately whenever you suspect a fracture, even if you think it is minor. After taking X rays, the physician will realign any broken bones that are out of normal position. The most severe fractures may require surgery to reset the bones into their proper place; or the doctor may decide it is best to brace a broken bone internally with metal screws, rods, or plates. Ordinarily, a doctor will simply align the bones and immobilize a broken arm or leg with rigid devices (splints) held in place with a bandage, with a plaster restraining tube called a cast, or with an inflated restraint, also called a cast.
Dislocations - A finger, thumb, or shoulder bone may be pulled out of the joint, usually by a fall or physical blow. Such a dislocation may damage ligaments and other tissues in the joint, which will become misshapen, swollen, and the source of intense pain. Get medical help as soon as possible. A doctor may be able to quickly realign the bones if internal damage is not serious and swelling has not progressed too far. Only someone with proper training should realign dislocated bones, however. Otherwise further damage may result. The joint will be immobilized with a cast or other device for about two weeks to allow ligaments and other tissues time to heal. Surgery may be necessary to repair severely damaged tissues.
Sprains - Any ligaments holding bones or cartilage together at a joint can be twisted, torn, or otherwise damaged by a fall or other injury. Ankle, knee, and finger joints are regularly subjected to force in daily use, so the ligaments at these joints tend to get sprained most often. A sprain's severity depends on how much damage has been done to the ligament. Stretching and small tears produce a mild sprain. They make the joint painful to move but still able to function. When ligaments are ruptured completely torn - the sprain is severe. There will usually be swelling and pain, and depending on the extent to which the ligaments are torn, the joint may look deformed. See a doctor for a severe sprain or if the pain of a mild one continues for more than two to three days. If X rays show severe tearing of the ligament, your doctor may recommend surgery to repair the damage. Otherwise the treatment may be nothing more than a splint or cast to immobilize the joint while ligaments heal. For mild sprains, wrap the joint with an elastic bandage and use an ice pack periodically during the first day or two to help keep swelling down. Start exercising the joint very gently after a day or two of rest and ice packs. Try building the ligament back up slowly without forcing it to take too much weight too soon. Keeping the joint elevated when possible helps reduce swelling.
Strains - As most athletes soon find out, muscle fibers will tear with too much exertion or stretching. You will probably feel some immediate pain if you tear a muscle, say, by lifting too much weight or by suddenly reaching out to catch a baseball. The muscle gradually becomes swollen, tender, and stiff. Muscle strains are nearly always minor and heal completely by themselves within a few days. But if the muscle will not function at all, it may be completely torn and you need to see a doctor. Be careful of less severe muscle strains as well. If you do not treat a serious muscle strain properly, or if you strain the muscle repeatedly, you may lose strength in the muscle permanently.
For minor muscle strains - An ice pack can help ease the pain and keep swelling down. An elastic bandage wrapped around the affected area also reduces swelling, but the bandage must not be so tight that it hampers blood circulation. If the pain or swelling is severe, get medical treatment. A doctor may recommend surgery for muscles that are torn completely. If the damage is less severe, a physician may prescribe medication for pain and tell you to rest the muscle for a specified period. If the muscle pull is bad enough, you might have to undergo physical therapy to rebuild muscle strength. You can usually prevent strains by doing warm-up exercises to get blood flowing to muscles and to increase muscle flexibility. Jogging in place for several minutes is one way to warm up. Another consists of going slowly through the motions of the activity you are about to perform. Once you have broken a light sweat, stop and stretch the muscles you will be using.
Overuse injuries - Some injuries to bones, joints, and muscles occur because of wear and tear over a long period. Called stress injuries, they frequently happen to tennis players, joggers, bicyclists, and other athletes who work out regularly, performing the same motions over and over again. Athletes are not the only ones to develop repetitive stress injuries. Carpal tunnel syndrome is most common among people who use a computer keyboard or mouse, although it also occurs in others who repeat the same hand motions.
Basketball players, runners, and aerobic dancers are among the various athletes who may suffer stress fractures of foot and leg bones. Usually these cracks are so small they do not even show on an X ray, but they can be quite painful. Caused by repetitive pounding against hard surfaces, stress fractures heal with sufficient rest from the activity. Runners may develop shin splints, a pain in the front of the lower leg. Sometimes it is just a minor muscle tear, a stress fracture of the bone, or an inflammation of the tissue covering the shinbone. Swollen muscles pressing against blood vessels (a condition called anterior compartment syndrome) also cause shin splints. In any case, resting for a week or two usually clears up the disorder.
Fractures, sprains, strains and dislocations may be hard for the lay person to tell apart. For this reason, first aid treatment of any of these conditions is handled as though the injury was a fracture.
Signs and symptoms of the above conditions may include a "grating" sensation of bones rubbing together, pain, tenderness, swelling, bruising and an inability to move the injured part.
Victims with traumatic injuries, such as those caused by automobile accidents, falls etc. should not be moved except by trained rescue workers. Head, neck and back injuries are serious and require special care for movement and transport of victims with these conditions. In exceptional circumstances, such as when a victim is at risk of further injury unless moved, the victim's head and neck should be stabilized and the body moved with minimal flexing of the head, neck or spinal cord.
ALL VICTIMS WITH FRACTURES, DISLOCATIONS, SPRAINS AND STRAINS REQUIRE PROFESSIONAL MEDICAL ATTENTION.