Fractures are generally divided into two categories: closed fractures and open fractures. A closed fracture means the skin and soft tissue remain intact without communication between broken bone ends and the external environment. An open fracture features a wound at the injury site, with fractured bone ends exposed to the outside world. Fractures may occur in any body part, among which limb fractures are the most prevalent.

If a fracture is suspected, minimize movement of the injured area and use rigid flat boards for transportation whenever possible. Below are the five essential first aid principles for fractures.

1. Prioritize Life Rescue

Saving life ranks first in on-site first aid for severe trauma. If the casualty’s heartbeat and breathing have ceased or are failing, immediately perform chest compressions and artificial respiration. For unconscious patients, keep the airway clear by promptly clearing foreign bodies from the mouth and throat. Acupuncture at acupoints such as Renzhong and Baihui can be administered to patients with altered mental status.

Open fractures are often accompanied by heavy bleeding, which can be controlled by compression bandaging with dressings. When tourniquets are used for massive hemorrhage, record the exact time of application. Loosen the tourniquet for 30 to 60 seconds every 30 minutes to prevent limb ischemic necrosis. All fracture patients with life-threatening conditions shall be transferred to hospital without delay.

2. Wound Management

For open wounds, apart from timely and proper hemostasis, cover the wound with sterile gauze or clean cloth right away to avoid further contamination. Remove surface foreign objects, but never push exposed bone ends back into the wound, as this will contaminate deep tissues. If disinfection supplies are available, rinse the wound with antiseptic solution such as potassium permanganate before bandaging and splinting.

3. Temporary Splinting

Prompt and proper splinting of broken limbs on site alleviates pain, prevents secondary damage to surrounding tissues, and facilitates safe transport. Splinting for emergency use is only temporary, so simplicity and effectiveness take priority over accurate bone reduction. Do not attempt to reset exposed bone ends in open fractures; fix the limb in its original position instead.

Improvised splints can be made from readily available materials including wooden sticks, planks, tree branches, canes or hard cardboard. Each splint should be long enough to immobilize the joints above and below the fracture site. If no rigid splints can be found, bind the injured limb to the body with cloth straps: secure a fractured upper limb to the chest wall with the forearm suspended, or tie a broken lower leg to the uninjured healthy leg for stabilization.

4. Appropriate Pain Relief

Intense pain after severe trauma may induce shock, so painkillers shall be administered as needed, including oral analgesic tablets or injectable analgesics such as 10 mg morphine or 50 mg pethidine. Morphine injection is contraindicated for patients with cranial or thoracic injuries, as it may suppress the respiratory center.

5. Safe Transportation

After on-site first aid, transfer the casualty to hospital rapidly and safely. Handle the patient gently during transit to avoid jolting or bumping the injured limb and worsening pain. Keep the casualty warm and allow mild, gentle movements when appropriate.