neurosurg

Fractures

Finger fractures are like toe fractures – very painful but if they aren’t compound (with a wound allowing exposure to the air) they don’t require treatment apart from strapping gently to the neighbouring finger or toe for support.

Ankle sprains may have an underlying fracture but usually there is exquisite tenderness and severe bruising and swelling and you can’t weight bear (stand ) on it. Often the only way you can tell is with an x-ray. Best advice is to stay off it and use a crutch. You can get someone to make a crutch from a tree branch. You put your armpit into the point where it branches and use it on the same side as the injury if you can’t take any weight on it or the opposite side from the injury if you can walk on it.

A wrist fracture is similar but when trekking, is less important as you can wait a few days or so before it has to be set. Keep a splint on it if you have access to one.

A lower leg fracture that is closed must not be walked on! Get a crutch and get to the nearest help. Plaster of Paris is ideal to immobilise the fracture but let’s face it who takes stuff like that on a trek?

If the fracture is compound i.e. bone sticking out, you have a real urgent emergency to deal with because of the risk of infection. Occasionally by straightening the limb in a splint the fracture reduces (goes back) but this is unlikely. If help is near at hand an antiseptic dressing over the exposed bone and a splint is all you can do and then evacuate the patient. Give antibiotics if you have some and expect the patient to be shocked (fast pulse low blood pressure, thirst and rapid breathing). Keep the patient reasonably warm and get help. If they tolerate it, relieve pain with whatever painkillers you have and encourage fluids.

I usually take stuff to stitch with and some local anaesthetic but there again I’m a medic aren’t I ?

The basic rules are :

1) Treat pain

2) Immobilise the fracture

3) Stay off it

4) Antiseptic dressings to wounds.