A break in a bone that pierces the skin is medically termed an open fracture. This is a severe orthopedic injury because the open wound creates a direct pathway for bacteria, leading to a high risk of deep bone infection (osteomyelitis). The combination of a broken bone and bleeding makes this a medical emergency requiring immediate professional treatment. Call 911 or your local emergency number without delay to activate emergency medical services.
Prioritizing Safety and Activating Emergency Services
Before approaching the injured person, assess the surrounding environment for potential dangers, such as traffic, fire, or unstable structures. Ensuring the scene is safe for both you and the patient is necessary. If the environment poses an immediate threat, move the injured person only the minimum distance required to reach safety, minimizing movement of the injured limb.
Immediately call emergency services and provide a clear description of the location, the injury, and the patient’s condition. While waiting for help, check the patient’s initial status, prioritizing consciousness and normal breathing over the broken limb. Instruct the injured person to remain as still as possible to prevent further damage from the fractured bone.
Maintaining communication with the emergency dispatcher provides guidance and helps coordinate medical personnel. Continual reassurance of the patient is also important, as fear and pain can contribute to systemic shock. Your role is to provide immediate, life-preserving first aid until trained professionals arrive.
Managing the Open Wound and Hemorrhage
Controlling blood loss from the open wound is the next priority, as significant bleeding can rapidly lead to hypovolemic shock. Apply firm, direct pressure to the wound using a clean cloth, sterile gauze, or any non-fluffy material to stop the flow of blood. If the material soaks through, do not remove the original dressing; instead, add more layers over the top and maintain continuous pressure.
Avoid attempting to clean the wound or manipulate the exposed bone back beneath the skin. Pushing the bone back risks introducing contaminants deeper into the tissues, increasing the chance of infection. Simply cover the entire wound site with the cleanest material available and secure it loosely enough to maintain pressure without restricting circulation.
If direct pressure does not control severe bleeding, you may apply pressure to the major artery supplying the limb. A tourniquet should only be considered as a last resort for life-threatening hemorrhage. Most external bleeding can be controlled with sustained, direct pressure over the injury site.
Stabilizing the Injured Limb
The injured limb must be immobilized to prevent movement, which reduces pain and minimizes further damage to muscle, nerves, and blood vessels. Splinting requires stabilizing the joints both above and below the fracture site to ensure the broken bone cannot shift. The limb should be splinted in the position it was found, even if it appears deformed, as attempting to straighten it can cause immense pain and worsen the injury.
A temporary splint can be created using rigid materials combined with soft padding. Examples of rigid materials include:
- Rolled newspapers
- Magazines
- Wooden boards
- A sturdy umbrella
Padding must be placed wherever the rigid material contacts the skin, especially around bony prominences, to prevent pressure sores and increase comfort.
For a leg injury, secure the splint material along the limb, extending past the knee and ankle, and tie it gently but firmly in several places above and below the fracture. For an arm injury, secure a smaller rigid splint, then place the arm into a sling made from a piece of cloth, keeping the elbow bent and secured against the chest.
After applying the splint, check the patient’s fingers or toes distal to the injury site for signs of compromised circulation. A properly applied splint should not cause the extremities to become cold, pale, or numb, and the pulse should remain detectable.
Monitoring the Patient and Preventing Shock
Ongoing observation of the injured person is necessary while awaiting professional medical help, focusing on monitoring for signs of systemic shock. Hypovolemic shock, resulting from significant blood loss, is a major concern with open fractures. Signs of developing shock include pale, cool, and clammy skin, a rapid and weak pulse, and fast, shallow breathing.
To help mitigate shock, lay the patient flat on their back and keep them warm by covering them with a blanket, coat, or anything available to prevent body heat loss. If the injury involves the arm, and there is no suspicion of a head, neck, or back injury, the patient’s legs can be slightly elevated to encourage blood flow toward the torso and brain. Continuously reassure the patient and speak to them calmly to manage anxiety, which can exacerbate the body’s stress response.
Re-checking the circulation in the injured limb’s extremities is an important part of patient monitoring. Look for any changes in the color, temperature, or sensation of the fingers or toes, as this may indicate that the splint or swelling is compromising blood flow. If these signs worsen, slightly loosen any ties on the splint that are not directly over the fracture site, and immediately report the change to the emergency dispatcher.