Fractures (broken bones), sprains (ligament injuries), strains (muscle or tendon injuries), and dislocations (bone displacement from a joint) are common musculoskeletal injuries. Proper first aid prevents further injury and reduces pain.

AED defibrillator device used in emergency response — Fractures and sprains require immobilization, RICE protocol (Rest, Ice, Compression, Elevation), and careful assessment for neurovascular compromise. Source: Unsplash.

Bandage applied to a fractured limb — Proper bandaging techniques help immobilize fractures and support injured joints during healing. Source: Unsplash.

Fractures

A fracture is a break in the structural continuity of bone. Closed fractures: skin is intact. Open (compound) fractures: bone pierces the skin or a wound leads to the fracture site — high risk of infection. Signs: pain (localized, severe, worsened by movement), swelling, bruising, deformity (angulation, shortening, rotation), loss of function, abnormal mobility, and crepitus (grating sensation). Open fractures may have visible bone. Fractures should not be manipulated or realigned in the field — this can damage nerves and blood vessels.

Splinting. Immobilize the joint above and below the fracture. Splint in the position found — do not attempt to straighten. Use a rigid splint (board, rolled magazine, broom handle) padded with soft material, secured with bandages or cloth strips. Check neurovascular status (pulse, sensation, movement) before and after splinting. Apply ice for pain and swelling. Elevate the injured extremity if possible.

Specific fractures. Hip fracture: the leg is shortened and externally rotated. Immobilize and transport with pillows between the legs. Femur fracture: a large bone loss can cause significant bleeding (1–2 L). Use a traction splint if trained. Pelvic fracture: high-risk for internal bleeding. Bind the pelvis with a sheet at the level of the greater trochanters. Spinal injury: suspect with any high-energy mechanism, fall from height, diving injury, or head injury. Do not move the patient unless necessary for airway or scene safety. Log-roll carefully maintaining spinal alignment, apply a cervical collar, and transport on a rigid backboard.

Sprains

A sprain is stretching or tearing of a ligament. Grade 1: mild stretching, microscopic tears, mild pain and swelling, no joint instability. Grade 2: partial ligament tear, moderate pain and swelling, some joint instability. Grade 3: complete ligament tear, severe pain and swelling, gross joint instability. The RICE protocol: Rest (restrict activity), Ice (apply for 20 minutes every 2–3 hours — reduces swelling and pain), Compression (elastic bandage — wrap distal to proximal, not too tight), and Elevation (above heart level reduces swelling). NSAIDs (ibuprofen, naproxen) reduce pain and inflammation.

Strains

A strain is stretching or tearing of a muscle or tendon. Acute strains result from sudden overstretching or overload. Chronic strains result from overuse. Grade 1: mild (muscle stretch). Grade 2: moderate (partial tear). Grade 3: severe (complete tear). Management: RICE protocol, NSAIDs, gradual return to activity. Muscle strains are common in the hamstrings, quadriceps, and back. Complete tendon ruptures (Achilles, biceps, rotator cuff) may require surgical repair.

Dislocations

A dislocation is displacement of a bone from its normal joint position. Common dislocations: shoulder (most common large joint — visible deformity, loss of shoulder contour), finger, elbow (high risk of nerve and vascular injury), and patella. Signs: severe pain, visible deformity, swelling, loss of function, and inability to move the joint. Do not attempt to reduce a dislocation (risk of nerve/vascular injury). Immobilize in the position found, apply ice, and transport to an emergency department. Shoulder dislocations are typically reduced with gentle traction and counter-traction under sedation.

★ Key Concept

Any patient with a high-energy mechanism (motor vehicle crash, fall from height, diving accident, sports collision) or with head injury, facial trauma, or impaired consciousness should be treated as having a potential spinal injury until proven otherwise. Signs: neck or back pain, numbness, tingling, weakness in extremities, loss of bladder or bowel control, and priapism. Management: manual spinal stabilization from the initial approach, apply a rigid cervical collar, secure the patient to a long backboard with head blocks, maintain neutral alignment, and minimize movement. Log-roll only when necessary (to clear airway, place on backboard). Do not remove a football helmet if spinal injury is suspected — remove only the face mask.

Summary

Fractures should be splinted in the position found. The RICE protocol (rest, ice, compression, elevation) manages sprains and strains. Dislocations should be immobilized and reduced only by medical professionals. Suspect spinal injury with high-energy mechanisms and maintain spinal precautions. Open fractures require urgent medical care and prophylactic antibiotics. Neurovascular status should be assessed before and after any immobilization.