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# 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
(IMG) Broken bone
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
(IMG) Dislocated joint
Deformed at a joint or unable to move a joint.
Sprain or Strain
(IMG) Sprain
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.
(IMG) Position arm
Step 2: Wrap a layer of bandage, gauze, or thin cloth or use a shirt
sleeve.
(IMG) Wrap a layer of bandage
Step 3: Rest the arm on the splint. Place a roll of fabric inside
the hand. For legs, splint along the side.
(IMG) Rest arm on splint
Step 4: Wrap around the splint with a bandage or strip of fabric to
hold it in place.
(IMG) Wrap around splint 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.
(IMG) Thigh splint
Splint a finger or toe to the one next to it. Put a little soft
padding in between them.
(IMG) Finger splint
Make a sling
You can use a sling to protect and support a wounded arm or shoulder.
(IMG) Sling
* 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.
(DIR) medicine for pain
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.
(IMG) Pull slowly
Step 4: When the pieces of bone are separated, gently line up the two
edges and let them come back together.
(IMG) Line up and let 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.
(IMG) Bent elbow
(IMG) Slightly bent knee
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.
(IMG) Form cast
Step 7: Smooth the inner wrapping over the edge of the cast.
(IMG) 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)
(IMG) Open fracture
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.
(DIR) antibiotics
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)
(IMG) Dislocation
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.
(DIR) medicine for pain
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.
(IMG) Bucket method
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.
(IMG) Thumb method
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.
(IMG) Rotation method
After, sling the arm to prevent it from slipping out of the joint
again.
(IMG) Sling
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.
(IMG) Pull arm towards you
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.
(IMG) Push straight down
IMPORTANT! If there is a lot of resistance, stop! You may break the
bone. Splint the elbow like this and get medical help.
(IMG) Splint elbow like this
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.
(IMG) Finger splint
## Sprains and strains: the twisting or tearing of muscles and
## ligaments
(IMG) Sprains
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
(IMG) Wrapping a bandage
* Start near the toes or fingers.
* Wrap firmly, but not so tight that toes or fingers get cold or
lose feeling.
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