Bones can break and bend in a few different ways. Different types of fracture can mean different complications and longer-term outcomes. Within the pre-hospital sector, you won’t be able to fully assess what type of fracture it is unless it is a compound fracture. Having an idea of the different types can be useful when making decisions for further care:
Stable fracture – Where the bone breaks and the broken ends line up, barely out of place
Compound fracture – As discussed, where the bone breaks and penetrates the skin
Transverse fracture – Where the fracture follows a horizontal fracture line
Oblique fracture – Where the fracture follows an angled pattern
Comminuted fracture – Where the bone has broken into 3 or more pieces
Pathological fracture – Where the bone has broken due to pathological means, e.g., disease
Stress fracture – Where there is a hairline fracture in the bone
The following fractures occur in children:
Greenstick fracture – The bone bends but doesn’t fracture all the way through
Buckle fracture – Occurs where the bones compress into each other causing one side of the bone to bend
Growth plate fracture – Occurring at the joint where the growth plate is located, this can affect the development of the bone, causing it to be shorter than its’ opposite
Amputations, partial amputations, and degloving – An amputation involves the complete severing of a limb, a partial amputation is an incomplete severing of the limb, and a degloving injury, also called an avulsion injury, is where the top layers of skin and tissue are ripped from the underlying muscle, connective tissue, or bone. When managing:
Laceration/Penetration injuries – Laceration and/or penetration injuries can range in severity depending on the MOI and factors involved. A simple laceration where there is no compromise to deeper tissues such as arteries/veins, tendons/ligaments, could be managed within a primary care setting with the use of Advanced Practitioners, or through Minor Injuries at Hospital. Where deeper tissues are affected, hospital admission will be needed to review the damage, and specialists will need to be involved to try and save the limbs’ function and ability.
On reviewing a simple laceration injury:
Where deeper tissues are affected, the patient will require transport to hospital for further assessment and care:
Where there has been a penetrating injury or significant laceration, there is the potential for major bleeding to occur. Significant arteries and veins run through the limbs, and a severing of these blood vessels could lead to significant blood loss. If there is bleeding from a penetrating or lacerating wound, follow the basic haemorrhage control steps to manage. If the haemorrhage continues and is unmanageable by basic means, or you feel the haemorrhage is of a catastrophic nature, follow catastrophic haemorrhage protocols: