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Fractures and soft tissue injuries


Head fractures
Neck and spinal injuries
Crush injury
Chest injuries
Soft tissue injuries


There are 206 bones in the human body and over 600 muscles. Bones and muscles work together to provide strength, support, protection and movement to the human body. When stressed or damaged, the body’s ability to move is affected. Sometimes severe injury to a bone can be life threatening.


A fracture is a broken or cracked bone. Fractures generally cause pain. Sometimes the pain is not detected until the bone is stressed by use. Swelling, tenderness, discoloration, and inability to move the affected body part are common. Sometimes deformity of the affected body part is noted. The location and severity of the fracture determine the signs and symptoms.

Drawing of a broken bone in a leg

Figure 9: Fracture

Types of fractures

If medical help is close by do not immobilise with splints and bandages. Instead support the effected area by placing padding either side to prevent movement.

Management of a fracture (general principles)

  1. DRABCD and get medical help as soon as possible.
  2. Keep the casualty still.
  3. Handle very gently. Keep movement of the injured area to an absolute minimum.
  4. Immobilise the limb or affected area using bandages and slings.
  5. Do not place bandages or direct pressure over the fracture site.
  6. Cover any wounds and control bleeding.
  7. Support the limb or affected area.
  8. Do not elevate the limb or affected area.
  9. Provide reassurance.
  10. Assess for and manage shock.

Note: Never try to put the broken bone back in place. If it is an open fracture, immobilise the protruding bone using a ring pad and bandage, covering the wound with a light bandage that does not cause pressure over the fracture.

Immobilising a fracture (general principles)

When immobilising a fracture it is important to:

Immobilisation of specific fracture sites

Note: Severe blood loss can occur particularly with fractured femur, so be aware to assess and manage shock.

Fractured limbs

Support as you find it, or in a position of comfort for the casualty. Seek medical assistance. If medical assistance is likely to be more than one hour away you may need to immobilise the fractured limb where possible. Place a splint or padding such as towels or clothing under the fracture and use broad bandages (where possible) to prevent movement at joints above and below the fracture. Apply an arm sling (for lower arm) or a collar and cuff sling (for upper arm) for support.

Fractured jaw

  1. If the casualty is unconscious, turn him or her on the side and support the jaw to keep the airway open.
  2. If the casualty is conscious, ask him or her to support their jaw if possible and assist them to sit in the position of greatest comfort , which is usually sitting up and leaning forward. Seek medical assistance.

Fractured pelvis

  1. If the casualty is conscious, lay him or her on their back with knees slightly bent and supported by a folded blanket or other improvised materials.
Drawing of legs with a rolled-up blanket placed under slightly bent knees

Figure 10: Management a fractured pelvis

  1. Keep the casualty still and as comfortable as possible. Note: The casualty may lose control of bodily functions, for example, loss of bowel or bladder control.

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Head fractures

A blow to the head, neck, back or spine can cause swelling, bleeding and complicated injuries that might involve damage to the nerves. All head, neck, back and spinal injuries are potentially life threatening and might involve changes to level of consciousness, speech, hearing and coordination of movement.

General principles

  1. Immobilise the head, neck and spine to prevent any form of movement.
  2. Closely monitor signs of life.

Fractured skull

  1. DRABCD and call 000 or 112 (digital mobile)
  2. Skull fractures can result in bleeding under the scalp, in the brain, and visible bleeding or straw coloured fluid leaking from the ear and/or nose.
  3. While supporting the casualty’s head, neck and spine, place the casualty in the recovery position with the bleeding side closest to the ground.
  4. Check ears. Blood or clear ooze leaking out of an ear indicates brain damage. In this case, using a sterile dressing under the casualty’s ear, get the casualty to lie down on their side with the affected side facing downwards. Place a pad or clean cloth under the bleeding ear or nose to collect the draining fluid.
  5. Closely monitor signs of life.
  6. Control bleeding but do not apply any direct pressure to the skull.
  7. Using a torch, the qualified first aider will check that pupils are of equal size and reacting to light. Enlarged pupils or pupils not reacting to light may indicate brain damage.(Can also indicate use of certain drugs / medications)

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Neck and spinal injuries

Velocity accidents, that is, accidents that involve speed and sudden halting, can cause head and spinal injuries. Examples are motor vehicle, bike, bicycle and pedestrian accidents, falls and diving accidents.

  1. DRABCD and call 000 or 112 (digital mobile)
  2. It is vital that the casualty is not moved unnecessarily, as this could cause further damage.
  3. If the casualty is conscious, ask if they can feel or move their fingers or toes. If they can’t, this will confirm paralysis. Do not move them unless their life may be in danger, or to provide basic life support.
  4. Seek medical assistance immediately.
  5. Prevent any movement of their body by supporting limbs with bags, pillows, rolled up towels, and so forth. Do not apply a cervical collar. Let the paramedics do that.

Note: The spinal cord may become further damaged if the casualty moves. Do not move the casualty who has a suspected spinal injury unless their life may be in danger, for example from fire, or in order to provide basic life support, for example CPR, or to place the casualty into the recovery position if unconscious and breathing.

The casualty who is unconscious and breathing

If the casualty is unconscious and breathing, maintaining an open airway is vital to life and therefore the casualty needs to be placed into the recovery position. For the casualty with suspected spinal injuries, great care must be taken when rolling the casualty so as to maintain alignment of the spine. This can be done using by 4-5 bystanders to assist in rolling the casualty ‘like a log’. The head, neck, spine and legs should be turned slowly and all at the same time to prevent any further trauma to the spinal cord.

Activity 2

Check your understanding of the management of fractures. Click here

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Crush injury

A crush injury occurs when a heavy weight has been applied to part of the body. For example, a heavy piece of machinery has trapped the casualty’s legs and crushed them.

Management of a crush injury

  1. DRABCD and call 000 or 112 (digital mobile).
  2. If it is safe and physically possible, all crushing forces should be removed as quickly as possible after the injury.
  3. Assess for and treat any injuries.
  4. Assess for and manage shock.
  5. Provide reassurance.
  6. Closely monitor for signs of life.

Caution — If the crushing force is not removed immediately, or very soon after the injury occurs, do not attempt to remove the object unless advised by medical personnel.

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Chest injuries

Chest injuries often occur in falls, crush injuries and car accidents. All severe chest injuries can be potentially life threatening as the ribs and chest protect some of our most vital organs.

It is important with any chest injury that you closely monitor the casualty for signs of life.

Management of a chest injury

  1. DRABCD and call 000 or 112 (digital mobile)
  2. If the casualty is unconscious, place them in the recovery position on their injured side.
  3. If the casualty is conscious, position them for most comfort (usually semi-sitting and leaning towards the injured side).
  4. Assess for and treat any injuries.
  5. Assess for and manage shock.
  6. Provide reassurance.

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Soft tissue injuries

Sprains, strains, bruising and dislocations are all examples of soft tissue injuries. If in doubt, treat them like a fracture. Excessive pain can indicate fracture.

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Sprain: A sprain occurs when ligaments around a joint have been stretched or torn.

Strain: A strain occurs when a muscle or tendon has been overstretched.

Bruising: A bruise occurs when the blood vessels below the skin are damaged. Bruising often results from a blow, knock or fall.

Dislocation: A dislocation is a joint injury that occurs when the bones around a joint have been displaced into an unnatural position. Associated soft tissue injury can occur.

Here is a summary of soft tissue injuries

Condition Signs and symptoms Management

Pain, tenderness; swelling


RICE (see below)


Pain, stiffness; swelling


RICE (see below)


Pain, tenderness; swelling, discolouration of the skin


RICE (see below)


Pain, inability to move part; joint deformed; swelling

DRABCD. If in doubt, manage as a fracture. DO NOT attempt to move bones back into place. Support in position found. Get medical help.

R.I.C.E Technique

Strains, sprains and bruises can be generally managed using the four step R.I.C.E. technique: Rest , Ice, Compression, Elevate

R – Rest the casualty and the injured part. As movement will increase the blood flow, swelling and pain to the area the aim is to keep the part rested and supported.

I – Ice (wrapped in a wet cloth) or cold compress is applied to the injured area. Apply for approximately 20 minutes, and then reapply every two hours for approximately 20 minutes for the first 24 hours, then approximately 20 minutes every four hours for the next 24 hours.

C – Compression is applied to the injured part through the application of a compression bandage. A crepe roller bandage is often used and should support the joint or affected area.

E – Elevate the injured part, if possible.

Drawing of a leg supported on three towels and a pack of ice on the shin

Figure 11: Rest and support the injured part

Caution — Using ice. Never apply ice directly to the skin as this can cause ice burns and discomfort.

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