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Open and Closed Fractures and How to Treat Them

There are two classifications of fractures, closed fractures and open fractures. Closed fractures include any fracture where the bone does not penetrate the skin (the skin stays closed). In such instances, proper treatment includes immobilizing the fracture and seeking medical help.

Open fractures occur when a bone or bone fragment breaks through the skin or the skin and bone are broken in a traumatic, crushing injury. Proper treatment for open fractures must also include concern for possible infection.

Recognizing Fractures:

An open fracture will typically be self evident due to the exposed bone. The following clues suggest you are dealing with a probable closed fracture:

  1. The victim felt a bone break or heard a "snap".
  2. The victim feels a grating sensation when he/she moves a limb. (This condition is known as crepitus.)
  3. One limb appears to be a different length, shape or size than the other, or is improperly angulated.
  4. Reddening of the skin around a fracture may appear shortly after the fall.
  5. The patient may not be able to move a limb or part of a limb (e.g., the arm, but not the fingers), or to do so produces intense pain.
  6. Loss of a pulse at the end of the extremity.
  7. Loss of sensation at the end of the extremity.
  8. Numbness or tingling sensations.
  9. Involuntary muscle spasms.
  10. Other unusual pain, such as intense pain in the rib cage when a victim takes a deep breath or coughs.

If you discover any of these symptoms and cannot attribute them to any other obvious cause, assume them to be a fracture.

Initial Care for Fractures

In treating fractures, an unhurried and careful approach is best. Few fractures are life threatening unless mishandled. Check the patient for any more serious injuries. Make sure someone is going for help, or call 911. Ensure your patient is breathing and that excessive bleeding is controlled and that all open wounds are protected as best you can from contamination. After these elements are satisfied you can deal with stabilization of the fracture.

If you can, carefully cut away all clothing near the fracture site. You need to make sure the fracture hasn't broken the skin and you may be able to use the cut away material to aid in splinting. If you find an open fracture, protect the wound from contamination as you would any other.

No matter how soon you expect to get medical help, you should immobilize all fractures to prevent additional injuries due to accidental movement or muscle spasms. Immobilization can be achieved many ways; the key points being not to worsen the situation while immobilizing and making sure to also immobilize the joints above and below any limb fracture.

DO NOT try to straighten angulations of a bent wrist, ankle or shoulder or attempt to straighten any dislocated joint!

When splinting using sticks or other "found" objects, try to make padding between the injured limb and splint using a jacket, shirt filled with grass, anything which can be reasonably secured and can help fill in the gaps between the limb and the splint material. Don't get carried away with this concept, but if you can handily make something up without delaying the splinting process, it will be more comfortable to the patient.

It is not always possible to tell with the naked eye if a bone has been fractured. In case of doubt, it is best to assume the victim has received a fracture and treat it accordingly.

First Aid to Arm, and Collarbone Fractures

Collarbone Fractures:

bulletA collarbone fracture is commonly caused by indirect force resulting from a fall on an outstretched hand or the point of the shoulder.
bulletCollarbone fracture due to a direct force are rare.

Symptoms and Signs:

bulletGeneral symptoms and signs of fracture.
bulletCasualty may support the arm on the injured side at the elbow and may keep the head inclined towards the injured side to relieve pain.


  1. Gently place the limb on the injured side across the casualty's chest with the fingertips almost resting on the opposite shoulder.
  2. Place padding between the limb and chest on the affected side.
  3. Support the limb and padding in an elevation sling.
  4. For additional support, secure the limb to the chest by applying aboard bandage over the sling, tie the knot in front on the uninjured side.
  5. Remove to hospital.

Arm Fractures:

Fractures can occur anywhere along the length of the upper-arm bone or the two forearm bones, and may involve the elbow and upper arm bone.


  1. Place a pad in the person's armpit.
  2. Use a padded splint.
  3. Support the lower arm with a narrow pad around the neck and wrist.
  4. Use a wide bandage to bind the upper arm to the chest.

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Last modified: October 15, 2016.