FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 131

CHAPTER 11
FRACTURES AND RELATED INJURIES
Joseph B. Serra, M.D.
Principal Contributor
Wilderness accidents often result in broken bones or joint and tendon injuries. Care for in-
dividuals with such injuries demands an understanding of them and their potential complic-
ations. The diagnosis of a fracture—or the absence of a fracture—without X-rays is particu-
larly challenging.
Fractures vary widely in severity. Fractures of small bones in the hands or feet may pro-
duce little pain or disability. Bone ends of a fractured hip may be driven into each other
(impacted) in such a manner that the fracture is stable, produces little deformity, and causes
little damage to the surrounding tissues. In contrast, bones can be so shattered the limb feels
as if no bone is present.
Fractures with a single, clean break are simple fractures. If the bone ends are driven into
each other with little or no displacement, the fracture is impacted. If the bone is broken in-
to one or more fragments, the fracture is comminuted . Vertebral fractures in which the bone
simplycollapsesastheresultoftraumaorosteoporosisare compression fractures.Whenthe
surrounding skin is intact, the fractures are closed . If the skin has been penetrated, the frac-
ture is open or compound .
Manyboneorjointinjuriesareofmajorsignificance, particularly insituationswhereim-
mobilization without food or shelter is life threatening. Disruption of major blood vessels
can produce severe hemorrhage; vascular obstruction can cause gangrene of extremities;
breaks in the skin can lead to chronic infections; damage to nerves may result in paralysis.
DIAGNOSIS
The following are the principal signs of a fracture:
Pain and tenderness
Swelling and discoloration
Deformity
Most fractures are painful, the pain is aggravated by movement or manipulation, and
the fracture site is sensitive. Swelling and discoloration are usually present. However, these
signs are not diagnostic and may occur with sprains or occasionally with simple contusions.
Obvious deformity is diagnostic of a fracture. Grating of the ends of the broken bones is
also diagnostic but may be too painful to use as a diagnostic test. One or both ends of the
bone can occasionally be seen in open fractures. A common sign of a fractured hip is short-
ening of the extremity by one to two inches and outward rotation of the foot.