!Broken Bones, Dislocations, and Sprains
General principles
------------------
First decide if the bone is broken or dislocated (out of joint),
or if there is a sprain to the ligaments that connect the bones.
It can be very hard to tell these injuries apart, and an x-ray
may be necessary to know for sure. If you cannot tell if it is
broken, dislocated or sprained, keep the body part still and get
help. It is also possible to have a combination of these
injuries.
Give paracetamol (acetaminophen) or ibuprofen to help with the pain.
Broken
------
Misshapen in the middle of a bone or pain at one specific
point on the bone, and little or no pain when it is kept
still. Sometimes a bone could be broken even without being
misshapen. An x-ray can tell you for sure if there is a
break.
Dislocated
----------
Deformed at a joint or unable to move a joint.
Sprain or Strain
----------------
Swelling and pain near a joint.
Broken bones
------------
Keep a broken bone still until someone with experience setting
bones can set it and put on a cast. To help keep it still, make
a splint from a folded piece of cardboard, a flat piece of
board, the stiff spine of a palm frond, or something else
straight and hard.
Make a splint
-------------
Step 1: Position the arm in its natural, resting position.
The elbow should be bent.
Step 2: Wrap a layer of bandage, gauze, or thin cloth or
use a shirt sleeve.
Step 3: Rest the arm on the splint. Place a roll of fabric
inside the hand. For legs, splint along the side.
Step 4: Wrap around the splint with a bandage or strip of
fabric to hold it in place.
Leave fingers and toes uncovered and check often that they
are warm and have normal feeling.
Splint a broken thigh bone from the hip all the way down to
the ankle.
Splint a finger or toe to the one next to it. Put a little
soft padding in between them.
Make a sling
------------
You can use a sling to protect and support a wounded arm or
shoulder.
* Fold a square of cloth into a triangle; rest the arm on
the fold.
* Support the elbow.
* Tie it behind the neck.
Set a bone
----------
If the bone is out of its natural position, setting it will
help it heal. But if you do not know how to set a bone
correctly, you can cause a lot of damage by doing it wrong.
Find an experienced bonesetter or community health worker
who knows how to do this well.
Step 1: First give pain medicine. You can also give an
anti‑anxiety medicine like lorazepam or diazepam
to help the person stay calm.
Step 2: Ask a helper to hold the part close to the body
still or tie it to something that will not move.
Step 3: Pull the more distant part with a slow, steady,
strong force. Do not yank, but pull hard enough
to separate the bones.
Step 4: When the pieces of bone are separated, gently line
up the two edges and let them come back together.
WARNING! Do not try to set a bone if the break seems to go
into the joint or if there seems to be more than one break,
leaving a "floating" piece of bone in the middle. Do not
jerk or force the bones in place. This can cause permanent
damage. Get help.
Make a cast
-----------
Casts can be made from pieces of cloth and a syrup or
plaster mix that dries hard.
In Mexico several different plants such as tepeguaje (a tree
of the bean family) and solda con solda (a huge, tree-
climbing arum lily) are used to make casts. In India,
traditional bone‑setters make casts using a mixture of egg
whites and herbs. The methods are similar. Any plant will do
if a syrup can be made from it that will dry hard and firm
and will not irritate the skin. Usually the plant is boiled
in water until a thick syrup forms. Or use Plaster of Paris
mixed with water.
Wait until the swelling has gone down before casting. This
can take up to a week. In the meantime, support the limb
with a splint and sling.
Step 1: Make sure the bones are aligned. Compare the
injured side to the uninjured side to make sure
both look and feel the same.
Step 2: Position an injured elbow so it is bent, with the
thumb up, and fingers slightly curved - as if
holding a glass.
Position a knee so it is slightly bent. The ankle
is bent as if the person were standing up.
Step 3: Wrap the area to be casted in a loose, thin layer
of cloth or a few layers of gauze. Cast an area
that includes the joint above and below the break.
Step 4: Then wrap in soft cotton or kapok. Give extra
padding to bony parts, but do not over‑pad,
especially around the broken part.
Step 5: Dip strips of flannel, clean sheets, or bandages in
the syrup or plaster mixture.
Step 6: Form a cast all around the area with layers of
bandage. Leave fingers and toes uncovered. Keep the
cast snug but not tight.
Step 7: Smooth the inner wrapping over the edge of the
cast.
After the cast is on, rest the limb and keep it elevated
when possible. Use crutches to avoid putting any weight on a
broken leg.
If, at any time after the cast is on, the fingers or toes
start to swell, feel more pain, turn red, pale, or blue, or
lose feeling, remove the cast immediately. Failing to cut
off a cast that is too tight can cause the person to lose
the limb.
How long does a broken bone take to heal? A young child
heals in a few weeks. An old person's bones take months and
may never heal properly.
Keep a cast on the arm for at least a month. Leg casts
should stay on for about 2 months.
To remove the cast, soak it in water and carefully cut it
off. After the cast is removed, be gentle with the broken
limb for the same amount of time as the cast was on. Slowly
start normal activities, such as putting weight on an
injured leg.
Bone broken through the skin (open fractures)
---------------------------------------------
Open fractures are very likely to become infected. Give one of
the following: ceftriaxone, cloxacillin, clindamycin, or
cephalexin, and get help. If you will be able to get to medical
help within a few hours, wash your hands, and clean the wound
very well with lots of flowing water for 5 minutes or more.
Without putting the bone back under the skin, splint the limb.
If you know you cannot get to help within about 5 hours, clean
the wound and bone ends without touching them. You may be able
to help the bone go back to its position under the skin by
pulling the limb in a straight line very gently (see Set a
bone). Do not use force and do not continue if the person says
it is hurting more. Then dress the wound lightly in sterile
gauze. Change the gauze often to avoid infection until the
person can be treated by an experienced health worker. If you
need to move the person, make a splint first to keep the limb in
the same position.
Dislocations (bone out of the joint)
------------------------------------
Re-set a dislocated bone as soon as you can. The longer you
wait, the more difficult and painful it will be to fix. If you
cannot get the bone back in the joint, splint to hold still in
the position that feels most comfortable, and get help.
A person with experience may know how to pull the bone gently
and slowly away from the joint, then let it "pop" back in
correctly. Often when a bone comes out of the joint, pain and
trauma make the muscles around it tighten which can prevent the
bone from returning to the joint. Helping the person calm down
and relax the muscles, and using an anti-anxiety medicine such
as diazepam, and a pain medicine such as ibuprofen, can make
resetting a dislocation possible.
After resetting a dislocated joint, keep it still for 2 or 3
weeks with a brace or sling. Use a general pain medicine such as
ibuprofen as needed. As soon as the pain has lessened enough to
allow movement, take the joint out of the sling every few hours
and gently flex or rotate it. For a shoulder, hang the arm down
and let it move back and forth and in small circles. Be gentle
with the joint for the following 2 or 3 months. Dislocations
take a long time to heal.
If pain is severe after resetting a dislocated joint, there may
be a broken bone.
Dislocated shoulder
-------------------
Have the person lie face down on a table or surface that is
high enough that the dislocated arm can hang down without
touching the ground. Ask the person to hold a bucket with 5
to 7 liters of water for 20 to 30 minutes. Tying an object
weighing 3 to 5 kilos to the person's wrist with a soft
cloth works too. This will tire the muscles so they relax,
pull the arm down, and allow the shoulder to go back into
place.
If the shoulder does not go back into place, gently but
firmly push on the tip of the scapula (wing bones) with your
thumb. The arm should 'clunk' back into place.
A different method is to have the person lie face up. Slowly
rotate the arm toward you. It is best to have a helper
holding the person's body still, so that just the arm moves.
After, sling the arm to prevent it from slipping out of the
joint again.
Dislocated elbow
----------------
Step 1: Have the person lie down, then place the forearm
straight in line with the upper arm to line up the
bones.
Step 2: Have a helper firmly hold the upper arm. Pull the
forearm towards you, and gently bend the elbow.
Step 3: Now push straight down on upper arm as you bend the
elbow the rest of the way. You should feel a
"clunk." Splint the elbow to prevent it from
slipping out of the joint again.
IMPORTANT! If there is a lot of resistance, stop! You may
break the bone. Splint the elbow like this and get medical
help.
Dislocated finger
-----------------
Firmly pull a dislocated finger out, and then push the base
of the bone into place to set it.
Splint the dislocated finger to the next finger.
Sprains and strains: the twisting or tearing of muscles and ligaments
---------------------------------------------------------------------
Signs
-----
* Swelling
* Pain
* Bruising or redness
Treatment
---------
* Rest: do not put weight on the injured part. Using a
sling or crutches can help.
* Ice: for about 30 minutes every 2 to 4 hours. Less often
after a few days.
* Compress: wrap firmly with a bandage.
* Elevate: raise the injured part using a pillow or folded
blankets. Elevate all the time at first, and every few
hours after a few days.
These measures will lessen pain and swelling. If started
right away and continued, they will help the injured part
heal more quickly and with fewer lasting problems.
Keep pressure and weight off the injury. Minor sprains and
strains usually take 1 to 2 weeks to heal.
How to wrap a bandage
---------------------
* Start near the toes or fingers.
* Wrap firmly, but not so tight that toes or fingers get
cold or lose feeling.
-----------------------------------------------------
from NEW WHERE THERE IS NO DOCTOR ©
Hesperian Health Guides 1919 Addison St Ste 304 Berkeley CA 94704
1.510.845.1447 hesperian@hesperian.org
-----------------------------------------------------