• Fractures

    What is a Fracture?

    A fracture is a complete break, a chip or a crack in a bone. Fractures can be open (the end of the broken bone breaks through the skin) or closed (the broken bone does not break through the skin).

    What Do Muscle, Bone and Joint Injuries Involve?

    Injuries to the muscles, bones and joints include sprains, strains, dislocations and fractures. You will likely not be able to tell the difference between these injuries, except in the cases of very deformed fractures and dislocations. Just remember two key points: Treat all injuries as potential fractures, and decide if a call to 9-1-1 is needed based on signs and symptoms.

    • A sprain occurs when a ligament is stretched, torn or damaged. Ligaments connect bones to bones at the joints. Sprains most commonly affect the ankle, knee, wrist and finger joints.
    • A strain occurs when a tendon or muscle is stretched, torn or damaged. Tendons connect muscles to bones. Strains often are caused by lifting something heavy or working a muscle too hard. They usually involve the muscles in the neck, back, thigh or the back of the lower leg. Some strains can reoccur, especially in the neck and back.
    • A dislocation occurs when the bones that meet at a joint move out of their normal position. This type of injury is usually caused by a violent force that tears the ligaments, allowing the bones to move out of place.
    • A fracture is a complete break, a chip or a crack in a bone. Fractures can be open (the end of the broken bone breaks through the skin) or closed (the broken bone does not break through the skin).

    Emergency Steps


    Check the scene safety, form an initial impression, obtain consent and put on PPE, as appropriate.


    Check for signs and symptoms.

    • Unable or unwilling to move injured area*
    • Bent, crooked or deformed injured area*
    • “Popping” or “snapping” at a time of injury*
    • “Grating” when trying to move injured area*
    • Coldness, numbness, tingling at or below injured area*
    • Bleeding or bone protruding through skin*
    • Injury to head, neck, spine, pelvis or upper leg*
    • Severe or multiple injuries*
    • Significant cause of injury*
    • Unable to safely move them*
    • Signs and symptoms of shock*
    • Pain, swelling & bruising
    • Signs of broken rib(s):
    • Small, shallow, uncomfortable, or painful breaths
    • Support of injured area

    *Note: Signs and symptoms with a * require immediate emergency medical treatment.


    Call 9-1-1 and get equipment if the person requires immediate emergency medical treatment.


    Give Care.

    General Care

    1. Treat all muscle and bone injuries as potential fractures.
    2. Have the person rest without moving or straightening the body part.
    3. If the wound is closed, apply a cold pack wrapped in a thin, dry towel to the area.
      1. Apply for no more than 20 minutes unless this causes pain.
      2. Wait 20 minutes before applying again.
    4. If the wound is open and bleeding, apply direct pressure to control bleeding.
    5. If 9-1-1 is not called, contact a healthcare provider and follow their guidance.
    6. Continue checking them as appropriate to determine if additional care is needed.
    7. Keep person from getting cold or overheated.
    8. Give care for shock, if necessary.
    9. Reassure person you will help and that EMS has been called (if appropriate).
    10. Watch for changes in condition, including breathing and responsiveness, and give care as appropriate and trained.
    11. If trained and need to move or transport for medical care, give care based on level of training.

    General Care: Rib Fracture

    1. Give the person a pillow or folded blanket to hold against the injured area.
    2. Have the person evaluated by a healthcare provider.
    3. Call 9-1-1 if they show signs of shock, have trouble breathing, or it is not possible to safely or comfortably move them for transport.
    4. While waiting for help to arrive, have them rest in a position to ease breathing.
      1. If head, neck or back injury is suspected, leave them in position found unless you must move for safety, to perform CPR or to control bleeding.
    5. Monitor the person’s breathing and give care for shock, if necessary.

    Fractures FAQs

    How do I check for circulation?

    When checking for circulation, check the skin on the side of the injury farthest from the heart (e.g., the hand or foot) for temperature, color and feeling. Also ask the person if there is any numbness or tingling.

    If the person has a suspected rib fracture, is it life-threatening?

    Although painful, a simple broken rib is rarely life-threatening. Broken ribs are less common in children than in adults, because children’s ribs are more flexible and tend to bend rather than break. However, while not breaking the rib, the force can severely bruise the lung tissue of children, which can be a life-threatening injury.

    If a person has a suspected pelvic fracture, is it life-threatening?

    Pelvic injuries are serious and should be considered life-threatening because of the risk of damage to major arteries or internal organs. Fractures of bones in this area may cause severe internal bleeding and are associated with an increased risk for death in older adults.

    If the person can move their limb or stand on it, does this mean they probably don’t have a broken bone?

    Not necessarily. An X-ray is usually required to diagnose a broken bone. The person may still have a broken bone, even if they can move their limb. If the injury causes pain or discomfort, and symptoms do not improve, seek medical advice.

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