Tuesday, September 30, 2008

Health Tip Tuesdays ~ Broken Bones, Dislocations and Sprains

I've let this column go because I got very few comments on it. Then again we rarely get any comments on anything! But a few people have said they actually learn something from these posts, so I'll give it another shot.

Today we're gonna talk about broken bones and joint dislocations. First let's clear up some terminology. I don't know why this happens, but alot of people say they have a "fracture" and not a broken bone. I guess that makes it sound worse than it actually is. But a fractured bone is a broken bone and a broken bone is a fractured bone. So whichever you want to call it, it's exactly the same.

If you or someone you know comes across someone who has injured themselves it's important to check for fractures and dislocations. Well, first you need to figure out of they're breathing or not!! Alot of the time you can actually see a fracture because there will probably be some deformity and swelling in that area. If you were there when the accident happened, it's possible you heard the bone break! That's kinda creepy! Sometimes you can see the bones(s) poking thru the skin, and in this case you can be pretty sure the bones are broken! This is called a compound fracture and it's not a pleasant sight. There will probably be alot of bleeding. You'll need to try to stop the bleeding if it doesn't stop on it's own.

If you suspect a fracture, you can ask the patient to move his/her fingers or toes or affected body part, but why?? It's HURTS to do that!! What you want to do with either a fracture, dislocation or sprain/strain (especially with the arm/hand/wrist or leg/ankle/foot or shoulder, check to see if the area is blue or grayish. If it is, that might mean the circulation is compromised and they need help quickly. You CAN gently tickle their finger tips or toes with your fingernails. If they say that feels normal that's a good sign. If not, it could mean there's nerve involvement and they need more help than you can probably give them.

Above are some pictures of dislocations. If there's a dislocation it's usually obvious but not always. Say it's a finger, that finger might be pointing in a direction different from all the other fingers. A dislocated shoulder looks larger than usual and deformed because it's been pulled out of the joint. You can't always be sure, but they just "look" different, but they still hurt ALOT and the patient can't move their arm, so please don't ask them to.

Also, if at all possible, don't ask them to walk if they've hurt their ankle/leg/foot. Not only does that hurt and can cause more damage, it's really ticks them off!! Be aware that a sprain can hurt as much, if not more than a fracture. So it gets a little tricky sometimes.

What can you do? Try to stablize the fracture. You can do this with a stick or board and some tape or strips of cloth. You can use a rolled up newspaper or a magazine folded into a gutter-type splint. This doesn't have to be fancy. Use whatever you have that is stiff and can be gently tied in place. Your goal here should be to immobilize the area and keep it from moving or bouncing around while you're on your way the the ER. The reason for this is, if the bones continue to move everytime the patient moves, it can cause alot of unnecessary internal tissue and vessel damage. Also, put some ice in a bag and place it over the area. Try to put a cloth between the ice and the skin tho. Don't use ice water - it's WAY too cold and can damage the skin.

Most importantly, you need to get them to a place where an x-ray can be taken to see what's going on. Fractures, dislocations and sprains need to be treated. If they're left to heal on their own, there will probably be some loss of function and deformity. You don't want that. Oh, and if your patient has a dislocation and needs a reduction (that means pulling the bone back in place) you might want to leave the room. That's unpleasant to watch!
See? All better! Well....sort of!


  1. WOW, what a post! I learned a LOT! thanks!

  2. Bob, thanks to you I have learned that my instinct in diagnosing and treating broken bones is about 100% off! I do ALL the things that you say not to do.
    I miss you already, Bob. I really wanted to come and say goodbye Monday morning, but we were running way behind, and it was either you or the plane ;-) It was great to see you and Rock, and so relatively often!

  3. So then, "Walk it off!" is not the best thing to say? Okay, I'll change.

  4. Having had three broken or fractured (thanks for clearing that up) I can RELATE totally to the PAIN!! Unbelieveable pain! Like I told the doctor's when I broke both bones in my left leg...put my uterus back in...I will birth ten more kids!!! ;-)