After reading this article, be sure to visit our trauma section
to see our fracture pictures.
What is a fracture? When the integrity of a bone is compromised
with a crack or break, it is called a fracture. I will often
ask patients if they have a history of any broken bones. They
will often say “no, just a crack.” The “crack”
they are referring to is a fracture. When there is a break
in the skin along with a fracture, it is called a compound
or open fracture. The bone may be sticking out--the classic
example of a compound fracture. What most people do not realize
is the following is also a compound fracture: A log or rock
falls on your toe or finger, the bone is broken and the skin
is lacerated and open. This is a classic “blowout”
laceration and it is an open fracture or compound fracture.
This is important because these individuals need to be protected
with a course of antibiotics. The last thing one wants is
a bone infection, called osteomyelitis. Compound fractures
take a long time to heal and are notoriously a problem. When
there is a doubt of a fracture or dislocation, always splint
the site in question and transport for x-rays.
The most common fracture before age 65 is a fracture of the
wrist. We trip, fall and reach out to support ourselves, hence
the broken wrist. After the age of 65, hip fractures are the
Pathophysiology of bones
To keep this as simple as possible, let’s review what
happens inside bones. Bone marrow is the spongy substance
found inside bones. It is where stem cells are born. Stem
cells are immature red and white blood cells and platelets.
When bones break they bleed, and blood loss can be a significant
factor, especially if a bone lacerates a nearby artery or
Now that we have reviewed some basic physiology we know what
to look for in the outdoors. When bones break, they bleed.
The individual will have pain and swelling due to tissue damage,
and swelling due to blood leaking out of the bone. Blood underneath
the skin is called a hematoma. This will not cause a blood
clot to the brain, heart or lungs. Many patients are fearful
in this regard, and reassurance needs to be given if they
bring this issue up. There may or may not be angulation of
the extremity compared to the other side of the body. Check
for color distally or farther away from the fracture site.
Also check for sensation. Do they have feeling farther away
from the fracture site? You want to document and be aware
of possible damage to nerves or arteries.
Pain management in the outdoors:
- Ibuprofen comes in 200 mg. tablets or capsules. An adult
can take 4 tablets, that’s
800 mg., with food to avoid stomach irritation, with 2 Acetaminophen
(Tylenol) at the
exact same time. This works very well as a pain reliever
in an outdoor setting.
- Ice if available at the site of injury.
- Reduce or not to reduce? Please see our dislocation article,
as much of the dislocation content also applies to fractures.
In reviewing this article via phone with many orthopedic
surgeons, the consensus is as follows:
- If you feel there is neurological or vascular compromise,
attempt to reduce as follows: Straighten the extremity.
This is not a sudden jerking motion, but a slow, deliberate
pressure with counter-traction if possible, and splint
in position. See our splinting section and photographs.
- If you are greater than 4-5 days out before treatment
at a healthcare provider, attempt to reduce the fracture
site and splint.
- If you can transport and get to a healthcare provider
in less than 4 days, splint in position, ice, elevate
- Irrigate, irrigate, irrigate. Direct pressure to
stop the bleeding, splint in position and once again,
if greater than 4-5 days to transport to a healthcare
provider, attempt reduction and splint.
1. Wilderness 911,
Weiss, M.D., Eric
2. Wilderness Medicine, Auerbach