bandages, strips of adhesive tape, clothing, or othersuitable materials. If possible, one person should holdthe splints in position while another person fastensthem.ApplicationAlthough splints should be applied snugly, theyshould never be tight enough to interfere with thecirculation of the blood. When you are applyingsplints to an arm or a leg, try to leave the fingers or toesexposed. If the tips of the fingers or toes become blueor cold, you will know that the splints or bandages aretoo tight. You should examine a splinted partapproximately every half hour and loosen thefastenings if the circulation appears to be impaired.Remember that any injured part is likely to swell, andsplints or bandages that are otherwise applied correctlymay later become too tight.MANAGEMENT OF BONEINJURIESLEARNING OBJECTIVE: Select theappropriate stabilization and treatmentprocedure for the management of boneinjuries.A break in a bone is called a fracture. There aretwo main kinds of fractures. A closed fracture is onein which the injury is entirely internal; the bone isbroken but there is no break in the skin. An openfractureis one in which there is an open wound in thetissues and the skin. Sometimes the open wound ismade when a sharp end of the broken bone pushes outthrough the flesh; sometimes it is made by an objectsuch as a bullet that penetrates from the outside.Figure 4-34 shows closed and open fractures.Open fractures are more serious than closedfractures. They usually involve extensive damage tothe tissues and are quite likely to become infected.Closed fractures are sometimes turned into openfractures by rough or careless handling of the victim.It is not always easy to recognize a fracture. Allfractures, whether closed or open, are likely to causesevere pain and shock; but the other symptoms mayvary considerably. A broken bone sometimes causesthe injured part to be deformed or to assume anunnatural position. Pain, discoloration, and swellingmay be localized at the fracture site, and there may be awobbly movement if the bone is broken clear through.It may be difficult or impossible for the victim to movethe injured part; if able to move it, there may be agrating sensation (crepitus) as the ends of the brokenbone rub against each other. However, if a bone iscracked rather than broken through, the victim may beable to move the injured part without much difficulty.An open fracture is easy to recognize if an end of thebroken bone protrudes through the flesh. If the bonedoes not protrude, however, you might see the externalwound but fail to recognize the broken bone.General GuidelinesIf you are required to give first aid to a person whohas suffered a fracture, you should follow these generalguidelines:If there is any possibility that a fracture has beensustained, treat the injury as a fracture until anX-ray can be made.Get the victim to a definitive care facility at thefirst possible opportunity. All fractures requiremedical treatment.Do not move the victim until the injured part hasbeen immobilized by splinting (unless the moveis necessary to save life or to prevent furtherinjury).4-46Figure 4-34.—Fractures: A. Closed; B. Open.
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