6. Fractures

Dislocation is diagnosed by looking at the deformity of the joint. These patients have severe pain, little or no movement of the affected joint, swelling, and possibly bruising. If it’s possible, an x-ray will give you a definitive diagnosis.

GEMalone, Own work, CC BY 3.0

As with a sprain, ice is applied locally, and the joint is brought back into place. This can usually be done easily without applying too much force, unless it is a large joint like your knee or shoulder. Fitting the joint is very painful but will bring great relief to the patient and, more importantly, eliminate the danger of vascular or neurological compression. After the joint is put back in place, it must be immobilized because it can become very unstable and dislocate several times. Depending on the joint, immobilization can be done with a sweater or pants by pressing the crossed arm forward against the body in the case of the shoulder or with boards, as explained for the sprain. This is if you don’t have the right device. The patient should be seen by a specialist as soon as possible to decide on the final course of action.

A fracture is the loss of continuity in a bone, either partially or completely. Fractures are caused by various traumatic mechanisms, from sprains to direct blows, penetrating injuries and even shock waves in healthy bones, or low-intensity blows in diseased bones with osteoporosis or cancer. Fractures are very painful because they damage the outer layer that covers the bone, called the periosteum, which contains the nerve endings. The diagnosis of the fracture can be intuited by analyzing the mechanism of the trauma together with the clinical signs. If you were not present at the time of the accident, it is important to ask how it happened, if he or she fell from a height or from their own height, and what the blow was against or what object hit the bone.

The fracture site will be seen to be enlarged by swelling and will be very painful and hypersensitive. If an x-ray is possible, that will make the definitive diagnosis. When you encounter or suspect a fracture, make sure the person does not move the fractured limb. Try to immobilize the fracture with one of the techniques I mentioned earlier for sprains and dislocations. In my country it is very common that when people have a fall or a trauma, they go to a specific place to get a special massage. These people (generally men) call themselves "sobadores” (rubbers). They are supposed to have special techniques to heal any kind of ailment, similar to what Mr. Miyagi did in Karate Kid. Along with this rubbing, they say prayers to promote healing. Sometimes people do get healed, but when there is a fracture, they only manage to make it worse because it can go from a simple fracture line to one with mobilization of both ends, which usually requires surgery. I think after reading this you might suspect that traumatologists hate “sobadores”.

After immobilizing and relieving the pain with a painkiller, check their pulse to assess for vascular involvement. The pulse of the radial artery in the arm is easy to feel. It is located in the wrist on the same side as the thumb.

Baedr-9439, Own work, CC0

Pia von Lützau

In the foot, the pulse of the pedal artery will give you information about the circulation of the whole member. It is located in the central part of the metatarsal.

In the figure below, you can see all the places where you can find the pulse.

Silentplanetart, Own work, CC BY-SA 4.0

Jmarchn, Own work, CC BY-SA 3.0