2. INTRODUCTION
Skeleton is a framework of bones.
Functions
Supports the tissues of the body.
Protects the vital organs.
Acts as levers that change magnitude and
direction of forces generated by muscles.
3. TYPES OF INJURY
Fracture
Dislocation
Muscle strain
Torn ligaments
4. FRACTURES
A break, split or crack in a bone
2 main categories of fractures
Open fracture
Closed fracture
Causes
Direct force
Indirect force
7. ASSESSMENT OF BONE, JOINT &
MUSCLE INJURIES
Note as many features as possible without
moving the injured part unnecessarily.
Try to visualise how the injury was caused.
Compare the shape, position and appearance
of the injured part with the uninjured side.
If in doubt about the severity of an injury, treat
it as a fracture.
8. ASSESSMENT OF BONE, JOINT &
MUSCLE INJURIES
Recognition of Fracture
Pain at or near the site of injury
Tenderness at or near site of fracture
Swelling & redness at or near site of injury
Loss of function
Deformity
Casualty feels or hear the break occur
Coarse grating sound is heard or felt
DO NOT try to produce this deliberately!
9. ASSESSMENT OF BONE, JOINT &
MUSCLE INJURIES
Recognition of Dislocation
Pain at or near the site of injury
Difficult or impossible normal movement
Loss of power
Swelling
Deformity or abnormal mobility
Tenderness
Discolouration and bruising
10. CLOSED FRACTURES &
DISLOCATIONS
Recognition
Pain, increased by movement
Shortening or unnatural shape to the limb
Tenderness, swelling & bruising at the site
There would have been a violent blow
or fall and there might have been a
snapping sound on impact.
11. CLOSED FRACTURES &
DISLOCATIONS
Treatment
Carefully stabilise and support the injured part with your
hands, holding above and below the injury.
If necessary, gently straighten a bent limb so you can
immobilise it. Always pull straight and steadily in the natural
line of the bone. Stop if pain is too great.
Use towels and bandages to immobilise the injured limb.
Immobilise lower limb fractures against the sound leg, with
padding between them.
12. CLOSED FRACTURES &
DISLOCATIONS
Treatment
Immobilise upper limb fractures against the trunk in a sling.
Call for an ambulance and treat for shock. Raise the injured
limb if possible, without causing pain or further injury.
Every 10 minutes, check circulation beyond the bandages
and loosen them if necessary.
DO NOT move casualty until the injury is supported and
immobilised (unless it is dangerous to stay at the scene)
DO NOT let casualty eat or drink anything.
13. OPEN FRACTURES
Recognition
Pain, increased by movement
Shortening or unnatural shape to the limb
Wound, with broken end of bone visible
There would have been a violent blow
or fall and there might have been a
snapping sound on impact.
14. OPEN FRACTURES
Treatment
Working from the uninjured side, cover the wound with a
sterile dressing.
Apply pressure around the bone to control bleeding.
Place cotton wool or padding over and around the dressing.
If bone protrudes from the wound, treat as an embedded
object.
Build up non-fluffy padding around the bone untill it is higher
than the bone.
15. OPEN FRACTURES
Treatment
Bandage dressing and padding securely to control bleeding
but without restricting circulation.
Immobilise the injured part, as for a closed fracture.
Call for an ambulance and treat for shock.
Every 10 minutes, check circulation beyond the bandages
and loosen them if necessary.
DO NOT move the casualty until the injury is supported and
immobilised (unless it is dangerous to stay at the scene).
16. OPEN FRACTURES
Treatment
DO NOT move the casualty until the injury is
supported and immobilised (unless it is
dangerous to stay at the scene).
DO NOT let the casualty eat or drink anything.
DO NOT press directly on a protruding bone end.
17. INJURIES TO THE FACE AND JAW
Recognition
Distortion of the eye sockets, nose, upper teeth
and palate.
Swelling and bruising.
Bleeding may occur from the nose or mouth or
tissue.
Also signs of head and neck injury.
18. INJURIES TO THE FACE AND JAW
Treatment
Open & clear casualty’s airway.
Place the casualty in recovery position.
Remains in the recovery position, if you have to carry the
casualty on stretcher.
If jawbone is injured, place soft padding under the head to
keep weight off the jaw.
DO NOT apply a jaw bandage.
19. INJURIES TO THE UPPER LIMB
FRACTURED COLLAR BONE
Recognition
Pain & tenderness at the
site of the injury.
Pain, increased by
movement.
Casualty may support
the arm at the elbow and
incline the head to the
injured side.
20. INJURIES TO THE UPPER LIMB
FRACTURED COLLAR BONE
Treatment
Place the injured arm across the chest and ask
the casualty to support at the elbow.
Apply an elevation sling.
Place soft padding between the injured arm and
the body.
Support with a broad bandage.
21. INJURIES TO THE UPPER LIMB
DISLOCATED SHOULDER
Recognition
Pain, increased by
movement.
Reluctance to move.
Casualty often supports
the arm and inclines the
head to the injured side.
A flat, angular look to the
shoulder.
22. INJURIES TO THE UPPER LIMB
DISLOCATED SHOULDER
Treatment
Place the injured arm across the chest gently at
an angle that causes the least pain.
Support the injured arm with an arm sling.
Send casualty to the hospital, keeping the
casualty in a seated position.
DO NOT replace the bone in position.
23. INJURIES TO THE UPPER LIMB
FRACTURED UPPER ARM
Recognition
Pain, increased by
movement.
Tenderness over the
fracture site.
Rapid swelling.
Bruising.
24. INJURIES TO THE UPPER LIMB
FRACTURED UPPER ARM
Treatment
Ask the casualty to sit down.
Gently place the injured arm across casualty’s
chest in the position that is most comfortable.
Ask the casualty to support the injured arm, if
possible.
Place the affected arm in an arm sling.
25. INJURIES TO THE UPPER LIMB
FRACTURED UPPER ARM
Treatment
Place soft padding between the arm and the
chest.
Secure the limb to the chest by tying a broad
bandage around the chest and over the sling.
Send the casualty to hospital, keeping the
casualty in a seated position.
26. INJURIES AROUND THE ELBOW
Recognition
Pain, increased by movement.
Tenderness over the fracture site.
Possible swelling and bruising.
Fixed elbow if the head of the radius is fractured.
27. INJURIES AROUND THE ELBOW
Treatment for an elbow that can bend
Treat as for a fracture of the upper arm.
Check the affected wrist pulse every 10 minutes.
Treatment for an elbow that cannot bend
Lay casualty down.
Place padding, such as cushions or towels around
the elbow for comfort and support.
28. INJURIES TO THE FOREARM &
WRIST
Recognition
Pain, increased by
movement.
Tenderness over the
fracture site.
Possible swelling &
bruising.
29. INJURIES TO THE FOREARM &
WRIST
Treatment
Ask the casualty to sit down.
Gently stabilise and support the injured forearm
across casualty’s chest.
If necessary, carefully expose and treat any
wound.
Place a triangular bandage between the chest
and the injured arm, as for an arm sling.
Gently surround the forearm in soft padding.
30. INJURIES TO THE FOREARM &
WRIST
Treatment
Tie the arm and its padding in an arm sling to
support it.
If necessary, secure the limb to the chest using a broad
bandage. Tie it over the sling, positioning it close to the
elbow.
Send the casualty to hospital and keeping casualty in a
seated position.
Can also use splint to support the injured forearm.
31. INJURIES TO THE HAND &
FINGERS
Treatment
Remove any rings before the hand begins to
swell.
Keep the hand raised to reduce swelling.
Protect the injured hand by wrapping it in folds of
soft padding.
Gently support the affected arm in an elevation
sling.
32. INJURIES TO THE HAND &
FINGERS
Treatment
If necessary, secure the arm to the chest by tying
a broad bandage around the chest and over the
sling.
Send casualty to hospital, keeping casualty in a
seated position.
Use the sound finger as a splint.
33. FRACTURES OF THE RIBCAGE
Recognition
Sharp pain at the site of fracture.
Pain on taking a deep breath.
Shallow breathing.
Paradoxical breathing
Chest moves in during inhalation, out during exhalation
An open wound over the fracture through which you might
hear air being “sucked” into the chest cavity.
Features of internal bleeding and shock.
34. FRACTURES OF THE RIBCAGE
Treatment for a fractured rib
Support the limb on the injured side in an arm
sling.
Send casualty to hospital.
35. FRACTURES OF THE RIBCAGE
Treatment for open/multiple fractures
Immediately cover and seal any wounds to the
chest wall.
Place casualty in the most comfortable position.
Half-sitting, head, shoulders and body turned towards
the injured side.
Support the limb on the injured side in an
elevation sling.
36. FRACTURES OF THE RIBCAGE
Treatment for open/multiple fractures
Call for an ambulance.
If casualty becomes unconscious, place casualty
in recovery position, uninjured side uppermost.
37. SPINAL INJURY
Causes
Falling from a height.
Falling awkwardly while doing gymnastics.
Diving into a shallow pool and hitting the bottom.
Being thrown from a horse or from a motorbike.
Being in a collapsed rugby scrum.
A heavy object falling across the back.
Injury to the head or face.
38. SPINAL INJURY
Recognition
When only the bones of the spinal column are
damaged, there may be:
Pain in the neck or the back at the level of injury
A step, irregularity, or twist in the normal curve of
the spine.
Tenderness on gently feeling the spine.
39. SPINAL INJURY
Recognition
When the spinal cord is also damaged, there may
be:
Loss of control over limbs; movement may be weak or
absent.
Loss of normal sensation.
Abnormal sensations such as burning or tingling.
Breathing difficulties.
40. SPINAL INJURY
CHECKING FOR SPINAL CORD INJURY
Examine the casualty carefully in the position
found
Ask helper to maintain support at casualty’s head.
Ask casualty to move limbs to test for loss of power.
Touch casualty without casualty knowing to test for loss of
sensation.
41. SPINAL INJURY
Treatment for a conscious casualty
DO NOT move the casualty from the position found,
unless he or she is in danger or becomes
unconscious.
Reassure the casualty and tell casualty not to move.
Stabilise and support casualty’s head in neutral
position by placing your hands over casualty’s ears.
Maintain this support throughout.
42. SPINAL INJURY
Treatment for a conscious casualty
If you suspect neck injury, get a helper to place
rolled-up blankets or articles of clothing on both
sides of the casualty’s neck and shoulders.
Call for an ambulance.
You may apply a collar if the neck is injured.
43. SPINAL INJURY
Treatment for an unconscious casualty
Check ABC & perform CPR if necessary.
Maintain airway.
Call for an ambulance.
Keep casualty’s head, trunk and toes in a straight line at all
times.
Check for pulse and breathing regularly.
44. FRACTURED PELVIS
Recognition
Inability to walk or even stand.
Pain & tenderness in the region of the hip, groin or back.
Increased when the casualty moves.
Blood at the urinary orifice especially in a male casualty.
The casualty may not be able to pass urine or may find this
painful.
Signs of shock & internal bleeding.
45. FRACTURED PELVIS
Treatment
Help casualty to lie on his or her back.
Straighten casualty’s leg or if it is more comfortable, help
casualty to bend his or her knees slightly and support them.
Immobilise his legs by bandaging them together, placing
padding between the bony points.
Call for an ambulance.
DO NOT bandage the legs together if this causes
intolerable pain.
46. INJURIES TO THE LOWER LIMB
HIP & THIGH FRACTURE
Recognition
Pain at the site of the injury.
Inability to walk.
Signs of shock.
Shortening of the thigh.
A turning outwards of the knee and foot.
47. INJURIES TO THE LOWER LIMB
HIP & THIGH FRACTURE
Treatment
Lay the casualty down gently.
Ask helper to stabilise and support the injured limb.
Gently straighten the lower leg and apply traction at the
angle, if appropriate.
Call for an ambulance.
Treat shock but do not raise casualty’s legs.
48. INJURIES TO THE LOWER LIMB
HIP & THIGH FRACTURE
Treatment
If ambulance is delayed, immobilise the limb by securing or
splinting it to the uninjured limb.
Gently bring the casualty’s sound limb alongside the injured
one.
Maintaining traction throughout at the ankle.
Insert padding between the thighs, knees and ankles.
Tie the bandages around casualty’s ankles and knees &
above and below the fracture.
Release traction only when all bandaging knots are tied.
49. INJURIES TO THE LOWER LIMB
HIP & THIGH FRACTURE
Treatment for transporting a casualty
over distance
Place a leg splint, from the armpit to the foot,
against side.
Pad between the legs and between the splint and
body.
Secure the splint and the body with bandages.
50. INJURIES TO THE LOWER LIMB
KNEE JOINT
Recognition
A recent twist or blow to the knee.
Pain, spreading from the injury to become deep-seated in
the joint.
If the bent knee has “locked”, acute pain on attempting to
straighten the leg.
Rapid swelling at the knee joint.
51. INJURIES TO THE LOWER LIMB
KNEE JOINT
Treatment
Help casualty to lie down.
Place soft padding under the injured knee to
support it in the most comfortable position.
Hold padding in place with bandage.
Send casualty to hospital.
52. INJURIES TO THE LOWER LIMB
KNEE JOINT
Treatment
DO NOT attempt to straighten the knee forcibly.
DO NOT give anything by mouth.
DO NOT allow the casualty to walk.
53. INJURIES TO THE LOWER LIMB
LOWER LEG
Recognition
Localised pain.
A recent blow or wrench of the foot.
Inability to walk.
Open wound may occur.
54. INJURIES TO THE LOWER LIMB
LOWER LEG
Treatment
Stabilise and support the injured leg.
Gently expose and treat any wound if necessary.
Straighten the leg using traction.
Support the leg with your hands until the
ambulance arrives.
55. INJURIES TO THE LOWER LIMB
LOWER LEG
Treatment
If ambulance is delayed:
Bring the sound limb to the injured leg.
Insert padding between the knees and ankles and
between the calves.
Tie the bandages firmly around ankles and knees,
then above and below the fracture.
