Sprain or Fractures

Muscular-Skeletal Injuries

Sprains, strains, dislocations, and fractures can all present with the same symptoms. It is very difficult to determine what the injury may be. It is not necessary to know which injury the victim has as the treatment will be the same for all of them.

If the patient has any of the following symptoms, you should treat for a possible muscle or skeletal injury.

  • Deformity at the injury site
  • A grinding or cracking sound when the affected area is moved (usually accompanied by extreme pain). (Do not test for this! It should be reported by the patient.)
  • Bruising and swelling
  • No pulse below injury site
  • Inability to use the affected body part normally

If the injury appears to be severe, EMS should be activated as soon as possible.


The treatment for any muscle, bone or joint injury follows the simple acronym “RICE”.

  • Rest – Rest is very important in the short term and for longer term care.
  • Immobilize – Sprains, strains and dislocations can be slinged; fractures should be splinted and slinged.
  • Cold – Ice should be applied periodically, for around 10-20 minutes at a time. You should then take the ice off for around the same time. Always place some fabric between the ice and the skin.
  • Elevation – Where appropriate, the injury should be elevated, as this may help reduce the localized swelling.
Do not elevate if this causes more pain to the victim.


Method of slinging depends on where the injury occurred on the arm. After applying a sling, ensure circulation to the arm has not been compromised by doing a distal circulation check. Moving an arm into a position where you can put a sling on it may be painful for the victim. If that is the case, simply immobilize in the position found. You will have to improvise something based on the victim’s position of comfort.

The arm sling – for injuries to the forearm

A splint and sling applied to the forearm. Note the second triangular bandage immobilizing the arm by holding it against the torso.

  • Support the injured forearm approximately parallel to the ground with the wrist slightly higher than the elbow.
  • This can be accomplished by using the victim’s shirt or sweater as a sling. Simply pin the bottom hem to their chest using multiple safety pins, going over the arm.

  • It is especially important for any sling that you ensure that circulation is not compromised – do distal circulation checks often

Thigh Bone Fractures

The thigh bone is the largest bone in the body, and has a large artery, the femoral artery, directly beside it. Because a mechanism of injury the femur is likely to also displace the fracture, it is possible that the femoral artery will be damaged internally. Damage to the femoral artery is likely to cause massive internal bleeding, so it is a major emergency; Call EMS immediately. Be sure to maintain as much immobilization as possible and monitor ABCs until EMS arrives.

Dislocated joint may be:

  • Accompanied by numbness or tingling at the joint or beyond it
  • Intensely painful, especially if you try to use the joint or bear weight on it
  • Limited in movement
  • Swollen or bruised
  • Visibly out of place, discolored, or misshapen

Treatment Review

  • 1. Call 911 before you begin treating someone who may have a dislocation, especially if the accident causing the injury may be life-threatening.
  • 2. If there has been a serious injury, check the person’s airway, breathing, and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
  • 3. Do not move the person if you think that the head, back, or leg has been injured. Keep the person still. Provide reassurance.
  • 4. If the skin is broken, take steps to prevent infection. Do not blow on the wound. Rinse the area gently with sterile water to remove obvious dirt, but do not scrub or probe. Cover the area with sterile dressings before immobilizing the injury.
  • 5. Splint or sling the injury in the position in which you found it. Do not move the joint. Be sure to immobilize the area above and below the injured joint.
  • 6. Check the person’s blood circulation around the injury by pressing firmly on the skin in the affected area. It should blanch white, and then regain color within a couple of seconds. Avoid this step if the skin has been broken, to reduce the risk of infection.
  • 7. Apply ice packs to ease pain and swelling.
  • 8. Take steps to prevent shock. Unless there is a head, leg, or back injury, lay the victim flat, elevate the feet about 12 inches, and cover the person with a coat or blanket.


  • Do NOT move the person unless the injury has been completely immobilized.
  • Do NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you are the only rescuer and the person must be moved away from danger, drag him or her by the clothing.
  • Cut away clothing, if possible, but don’t move the injured leg to do so.
  • Follow instructions for R.I.C.E., the first letters of rest, ice, compression and elevation.
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