Skeletal Trauma – Fractures – EMS SG

Traumatic Fractures: Anatomy, Physiology, and Management for Paramedics

Section 1: Understanding Traumatic Fractures

Fractures are common traumatic injuries in which bones break due to external forces. As paramedics, understanding the different types of fractures, their effects on anatomy and physiology, and the appropriate treatments is crucial for providing effective care to patients with these injuries.

I. Closed Fractures

Definition:

• Closed fractures, also known as simple fractures, occur when the bone breaks but does not pierce the skin.

Effects on Anatomy and Physiology:

• Closed fractures can cause significant pain, swelling, and deformity at the fracture site. There may also be localized bruising or discoloration.
• Blood vessels and nerves in the vicinity of the fracture can be affected, leading to compromised blood flow and sensory changes.

Treatment:

• Paramedics stabilize the affected limb using splints or rigid supports to immobilize the fracture. Immobilization helps reduce pain and prevents further damage during transportation.
• Pain management may be provided to alleviate discomfort during transport to the medical facility.

II. Open Fractures

Definition:

• Open fractures, also called compound fractures, involve a break in the bone where the bone pierces through the skin, creating an open wound.

Effects on Anatomy and Physiology:

• Open fractures pose a higher risk of infection due to the exposure of the bone to the external environment. The risk of soft tissue damage and blood loss is also increased.
• The open wound may contain foreign materials or debris, which can complicate wound healing and increase the risk of infection.

Treatment:

• Paramedics provide immediate wound care, such as covering the wound with sterile dressings to minimize the risk of infection. They avoid putting pressure directly on the exposed bone.
• Immobilization is crucial to prevent movement and additional injury during transport. Splints or rigid supports are used to stabilize the limb.

III. Greenstick Fractures

Definition:

• Greenstick fractures are incomplete fractures where the bone bends and partially breaks, often seen in pediatric patients due to the flexibility of their bones.

Effects on Anatomy and Physiology:

• Greenstick fractures cause localized pain and swelling, and there might be a visible bend in the affected bone. The bone remains intact on one side, while the other side exhibits a crack.

Treatment:

• Paramedics immobilize the limb with a splint or casting, providing support to the fractured area until further treatment is administered at a medical facility.
• They assess for any additional injuries, as greenstick fractures often coexist with other traumatic injuries in young patients.

IV. Comminuted Fractures

Definition:

• Comminuted fractures involve the bone breaking into multiple fragments or pieces.

Effects on Anatomy and Physiology:

• Comminuted fractures can result in extensive soft tissue damage, increased pain, and an increased risk of complications like infection and delayed healing.
• The presence of multiple bone fragments makes stabilization and immobilization challenging.

Treatment:

• Paramedics provide appropriate pain management and carefully immobilize the limb to prevent movement and further damage during transportation.
• Splints may be customized to support the multiple fragments and stabilize the affected area effectively.

V. Pathological Fractures

Definition:

• Pathological fractures occur in weakened bones due to pre-existing conditions like osteoporosis or bone tumors.

Effects on Anatomy and Physiology:

• Pathological fractures are prone to occur with minimal force and can lead to severe pain and deformity.
• The underlying condition causing bone weakness may require specialized treatment and further evaluation.

Treatment:

• Paramedics must be cautious during handling and transportation of patients with pathological fractures, providing gentle immobilization and pain relief while minimizing additional trauma to the affected bone.
• If there is a known underlying condition causing bone fragility, the information must be communicated to the receiving medical facility for appropriate follow-up care.

Conclusion:

Understanding the various types of traumatic fractures, their impact on anatomy and physiology, and the appropriate treatment strategies is essential for paramedics to provide skilled and compassionate care to patients in distress. By applying the knowledge presented in this chapter, paramedics can confidently assess and manage fractures in the field, ultimately optimizing patient outcomes and promoting efficient recovery.