How To Treat Broken Bones

There are several types of injury that affect extremities (arms and legs): broken bones (fractures), dislocations, sprains and strains. All extremity injuries need to be treated as broken bones until an X-ray can be obtained.

Persistent pain and swelling following an injury warrants a trip to the doctor. When the body doesn't look the way you expect it to, it's known as a deformity.

Deformities can come from swelling or bruising. Most of the time, they come from broken bones or joint dislocations. When a bone has been moved out of its usual position, the anatomy just looks wrong. That's a deformity.

Deformity is an example of a sign, rather than a symptom.

When assessing potential injuries, paramedics look for deformities as well as bruising and swelling. Broken bone fragments also can grind together to create crepitus. EMS workers will often try to move a suspected broken bone -- just a little bit -- to see if they feel crepitus. To understand how crepitus feels, fill a plastic bag with gravel and squeeze it.

In the case of arthritis, inflamed joint surfaces may grind together, a sensation a person may feel.

Another type of crepitus comes from little bubbles of air trapped in the spaces under the skin -- called subcutaneous emphysema. The little bubbles feel almost like weak bubble wrap.Sometimes, instead of crepitus, we feel nothing where there should be solid bone -- that's never a good sign.

1. Stay Safe! The patient was injured somehow. Don't get hurt the same way. Follow universal precautions and wear personal protective equipment if you have it.
2. If the foot or hand at the end of the injured extremity is cold or blue, call 911 immediately!
3. Do NOT straighten the extremity if it is deformed--keep it in the position found.
4. Stabilize the extremity. Use padding to keep it immobile. Specific broken bones need specific treatment:
   • broken leg
   • broken arm
   • broken ankle
   • broken foot
   • broken wrist
5. Put ice on the injury. Never put the ice directly on the skin--put it in a bag first with a layer of cloth between the bag and the skin. After holding ice on the injury for about 20 minutes, take it off for 20 minutes.
6. Elevate the extremity to reduce swelling.
7. Anti-inflammatory drugs like ibuprofen or naproxen will help with pain.
8. If 911 was not called, seek medical assistance for additional pain relief and further evaluation of the injury. The use of an ambulance is probably not necessary, but ambulances in many areas are capable of providing additional pain relief.

1. A little water in the ice bag will help it conform to the shape of the injury.
2. Compression wraps may also help reduce swelling, although the evidence is not compelling. Wrap the extremity about 4-6 inches above and below the injury. The wrap should be snug, but loose enough to fit one finger under the elastic bandage.