Hesperian Health Guides

Broken Bones, Dislocations, and Sprains

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HealthWiki > New Where There Is No Doctor > First Aid > Broken Bones, Dislocations, and Sprains


First decide if the bone is broken or dislocated (out of joint), or if there is a sprain to the ligaments that connect the bones. It can be very hard to tell these injuries apart, and an x-ray may be necessary to know for sure. If you cannot tell if it is broken, dislocated or sprained, keep the body part still and get help. It is also possible to have a combination of these injuries.

Give paracetamol (acetaminophen) or ibuprofen to help with the pain.

a broken arm.
Broken

Misshapen in the middle of a bone or pain at one specific point on the bone, and little or no pain when it is kept still. Sometimes a bone could be broken even without being misshapen. An x-ray can tell you for sure if there is a break.
a dislocated shoulder.
Dislocated

Deformed at a joint or unable to move a joint.
a swollen wrist.
Sprain or Strain

Swelling and pain near a joint.

Broken bones

Keep a broken bone still until someone with experience setting bones can set it and put on a cast. To help keep it still, make a splint from a folded piece of cardboard, a flat piece of board, the stiff spine of a palm frond, or something else straight and hard.

Make a splint

Step 1:
Position the arm in its natural, resting position. The elbow should be bent.
NWTND fa Page 29-1.png
Step 2:
Wrap a layer of bandage, gauze, or thin cloth or use a shirt sleeve.
NWTND fa Page 29-2.png
Step 3: Rest the arm on the splint. Place a roll of fabric inside the hand. For legs, splint along the side.
NWTND fa Page 29-3.png
Step 4: Wrap around the splint with a bandage or strip of fabric to hold it in place.
NWTND fa Page 29-4.png

Leave fingers and toes uncovered and check often that they are warm and have normal feeling.

NWTND fa Page 29-5.png
Splint a broken thigh bone from the hip all the way down to the ankle.
NWTND fa Page 29-6.png
Splint a finger or toe to the one next to it. Put a little soft padding in between them.

Make a sling

You can use a sling to protect and support a wounded arm or shoulder.

Fold a square of cloth into a triangle; rest the arm on the fold.
Support the
elbow.
Tie it behind
the neck.

Set a bone

If the bone is out of its natural position, setting it will help it heal. But if you do not know how to set a bone correctly, you can cause a lot of damage by doing it wrong. Find an experienced bonesetter or community health worker who knows how to do this well.

Step 1:
First give pain medicine. You can also give an anti‑anxiety medicine like lorazepam or diazepam to help the person stay calm.

Step 2:
Ask a helper to hold the part close to the body still or tie it to something that will not move.

illustration of the below: pulling on a broken forearm.

Step 3:
Pull the more distant part with a slow, steady, strong force. Do not yank, but pull hard enough to separate the bones.

illustration of the below: setting the bones.

Step 4:
When the pieces of bone are separated, gently line up the two edges and let them come back together.


WARNING! Do not try to set a bone if the break seems to go into the joint or if there seems to be more than one break, leaving a “floating” piece of bone in the middle. Do not jerk or force the bones in place. This can cause permanent damage. Get help.


Make a cast

Casts can be made from pieces of cloth and a syrup or plaster mix that dries hard.

In Mexico several different plants such as tepeguaje (a tree of the bean family) and solda con solda (a huge, tree-climbing arum lily) are used to make casts. In India, traditional bone‑setters make casts using a mixture of egg whites and herbs. The methods are similar. Any plant will do if a syrup can be made from it that will dry hard and firm and will not irritate the skin. Usually the plant is boiled in water until a thick syrup forms. Or use Plaster of Paris mixed with water.

Wait until the swelling has gone down before casting. This can take up to a week. In the meantime, support the limb with a splint and sling.

Step 1:
Make sure the bones are aligned. Compare the injured side to the uninjured side to make sure both look and feel the same.
Step 2:

Position an injured elbow so it is bent, with the thumb up, and fingers slightly curved—as if holding a glass.
NWTND fa Page 31-1.png
Position a knee so it is slightly bent. The ankle is bent as if the person were standing up.
NWTND fa Page 31-2.png

Step 3:
Wrap the area to be casted in a loose, thin layer of cloth or a few layers of gauze. Cast an area that includes the joint above and below the break.

Step 4:
Then wrap in soft cotton or kapok. Give extra padding to bony parts, but do not over‑pad, especially around the broken part.

Step 5:
Dip strips of flannel, clean sheets, or bandages in the syrup or plaster mixture.

NWTND fa Page 31-3.png

Step 6:
Form a cast all around the area with layers of bandage. Leave fingers and toes uncovered. Keep the cast snug but not tight.

NWTND fa Page 31-4.png
illustration of the below: folding the inner wrapping over the cast.

Step 7:
Smooth the inner wrapping over the edge of the cast, like this:

After the cast is on, rest the limb and keep it elevated when possible. Use crutches to avoid putting any weight on a broken leg.

If, at any time after the cast is on, the fingers or toes start to swell, feel more pain, turn red, pale, or blue, or lose feeling, remove the cast immediately. Failing to cut off a cast that is too tight can cause the person to lose the limb.

How long does a broken bone take to heal? A young child heals in a few weeks. An old person’s bones take months and may never heal properly.

Keep a cast on the arm for at least a month. Leg casts should stay on for about 2 months.

To remove the cast, soak it in water and carefully cut it off. After the cast is removed, be gentle with the broken limb for the same amount of time as the cast was on. Slowly start normal activities, such as putting weight on an injured leg.

Bone broken through the skin (open fractures)


NWTND fa Page 32-1.png

Open fractures are very likely to become infected. Give one of the following: ceftriaxone, cloxacillin, clindamycin, or cephalexin, and get help. If you will be able to get to medical help within a few hours, wash your hands, and clean the wound very well with lots of flowing water for 5 minutes or more. Without putting the bone back under the skin, splint the limb.

If you know you cannot get to help within about 5 hours, clean the wound and bone ends without touching them. You may be able to help the bone go back to its position under the skin by pulling the limb in a straight line very gently (see Set a bone). Do not use force and do not continue if the person says it is hurting more. Then dress the wound lightly in sterile gauze. Change the gauze often to avoid infection until the person can be treated by an experienced health worker. If you need to move the person, make a splint first to keep the limb in the same position.

Dislocations (bone out of the joint)

NWTND fa Page 32-2.png

Re-set a dislocated bone as soon as you can. The longer you wait, the more difficult and painful it will be to fix. If you cannot get the bone back in the joint, splint to hold still in the position that feels most comfortable, and get help.

A person with experience may know how to pull the bone gently and slowly away from the joint, then let it “pop” back in correctly. Often when a bone comes out of the joint, pain and trauma make the muscles around it tighten which can prevent the bone from returning to the joint. Helping the person calm down and relax the muscles, and using an [[|anti-anxiety medicine such as diazepam, and a pain medicine such as ibuprofen, can make resetting a dislocation possible.

After resetting a dislocated joint, keep it still for 2 or 3 weeks with a brace or sling. Use a general pain medicine such as ibuprofen as needed. As soon as the pain has lessened enough to allow movement, take the joint out of the sling every few hours and gently flex or rotate it. For a shoulder, hang the arm down and let it move back and forth and in small circles. Be gentle with the joint for the following 2 or 3 months. Dislocations take a long time to heal.

If pain is severe after resetting a dislocated joint, there may be a broken bone.


Dislocated shoulder

a man on an elevated table holding a bucket to straighten his shoulder.

Have the person lie face down on a table or surface that is high enough that the dislocated arm can hang down without touching the ground. Ask the person to hold a bucket with 5 to 7 liters of water for 20 to 30 minutes. Tying an object weighing 3 to 5 kilos to the person’s wrist with a soft cloth works too. This will tire the muscles so they relax, pull the arm down, and allow the shoulder to go back into place.

If the shoulder does not go back into place, gently but firmly push on the tip of the scapula (wing bones) with your thumb. The arm should ‘clunk’ back into place.

a man pushing on another man's scapula.


A different method is to have the person lie face up. Slowly rotate the arm toward you like this. It is best to have a helper holding the person’s body still, so that just the arm moves.
a man lying on his back while another man rotates his arm.
After, sling the arm like this to prevent it from slipping out of the joint again:
a sling for the arm that keeps the shoulder in place.

Dislocated elbow


Step 1:
Have the person lie down, then place the forearm straight in line with the upper arm to line up the bones.

NWTND fa Page 34-1.png


Step 2:

Have a helper firmly hold the upper arm. Pull the forearm towards you, and gently bend the elbow.
NWTND fa Page 34-2.png


Step 3:

Now push straight down on upper arm as you bend the elbow the rest of the way. You should feel a “clunk.” Splint the elbow to prevent it from slipping out of the joint again.

illustration of the above: an arm splinted from the wrist to above the elbow.
IMPORTANT! If there is a lot of resistance, stop! You may break the bone. Splint the elbow like this and get medical help.

Dislocated finger

Firmly pull a dislocated finger out, and then push the base of the bone into place to set it.

NWTND fa Page 34-4.png
Splint the dislocated
finger to the next finger.

Sprains and strains: the twisting or tearing of muscles and ligaments

NWTND fa Page 35-1.png
Signs
  • Swelling
  • Pain
  • Bruising or redness
Treatment
  • Rest: do not put weight on the injured part. Using a sling or crutches can help.
  • Ice: for about 30 minutes every 2 to 4 hours. Less often after a few days.
  • Compress: wrap firmly with a bandage.
  • Elevate: raise the injured part using a pillow or folded blankets. Elevate all the time at first, and every few hours after a few days.


These measures will lessen pain and swelling. If started right away and continued, they will help the injured part heal more quickly and with fewer lasting problems.

Keep pressure and weight off the injury. Minor sprains and strains usually take 1 to 2 weeks to heal.

Wrap firmly, but not so tight that toes or fingers get cold or lose feeling.

How to wrap a bandage

wrapping a bandage around a person's foot and ankle.
Start near the
toes or fingers.
Wrap firmly, but not too tight. The toes or fingers should feel warm
and have normal felling in them.
This page was updated:05 Feb 2020