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Student Education

First aid: fractures

BMJ 2005; 331 doi: https://doi.org/10.1136/sbmj.0507281 (Published 01 July 2005) Cite this as: BMJ 2005;331:0507281
  1. Martin S Roth, first year anesthesia resident1,
  2. Fernando D Perin, first year traumatology resident2,
  3. Fabian J Garcia, resident instructor3,
  4. Isabel Pincemin, clinician4,
  5. Samena Chaudhry, senior house officer in cardiothoracic surgery5
  1. 1Hospital Italiano de Buenos Aires
  2. 2Hospital Belgrano
  3. 3Hospital Municipal de San Isidro
  4. 4Hospital Municipal de San Isidro
  5. 5University Hospital North Staffordshire

In the fifth part of our series, Martin Roth and colleagues explain the classification of fractures and give some basic advice about managing them in a first aid setting

We can define a fracture simply as the breaking of bone. Whenever you apply more pressure than the bone can stand it will break. The size shape and consistency of bone varies with age. Old bones need less force to break them than young ones because they are more brittle and may be affected by osteoporosis. Bone is a living tissue with a generous blood supply and can bleed profusely after injury. Blood loss from limb wounds and bleeding from fractures can be severe enough to cause hypovolaemic shock (table). Haemorrhage from multiple fractures, especially pelvic and femoral, may result in an excessive loss of blood.1 For an open fracture the blood loss will be two to three times greater.

Classification of fractures

Although you can classify fractures in several ways, one important way to define them is either open or closed (box 1). Fractures in which the broken bone protrudes through the skin or communicates with a wound are called “open” or compound fractures. Exposure of the fracture to the external environment produces local contamination and increases the risk of infection.

Box 1: Open and closed fractures

Open fractures have a surface wound that leads from the overlying skin to the fracture site. The skin damage may have been produced by a blunt injury, penetrating injury, or caused by the bone itself, rupturing the skin at the time of the injury.

Closed fractures have no overlying skin wound but may still involve subcutaneous damage.

Subluxation and dislocation

Trauma can also lead to a partial (subluxation) or complete (dislocation) loss of congruity between the articulating surfaces of a joint. These may also be associated with fractures of one or more bones.

If …

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