HAR D TI S SU E IN JU R I E S

FRACTURES
DISLOCATION
Hard tissue injuries include fractures, dislocations and loss of teeth. That is, any injury to the
skeletal system.

A fracture is the technical term for a broken bone and there are various types of fracture with
various degrees of complication. The other main hard tissue injury is a dislocation.

A dislocation is when a joint is displaced. There are some joints more susceptible to dislocation than
others and dislocations always result in various soft tissue injuries as well.

Hard tissue injuries need to be assessed and managed quickly. The first aid response of DRSABCD
should always be followed when dealing with injuries.

In sport TOTAPS is also likely to be used in the assessment of the injury to determine the nature
and extent of the injury and if the athlete can continue to play. Once a hard tissue injury is identified
it should be immobilised and medical attention sought as soon as possible.
Classification of fractures
Fractures are a very common hard tissue injury and are also known as breaks. A fracture is a broken bone and
comes in three (3) classifications.
A closed fracture remains inside the body and does not pierce the skin. These are the most common broken
bones that occur. They are also known as simple fractures.
An open fracture is a break that does pierce the skin so that bone can be seen. These are also known as
compound fractures, because there is more than one (1) issue that needs to be addressed (i.e. bleeding, open
wound etc).
Complicated fractures are where the bone causes further damage to major nerves, organs or blood vessels.
These are complicated because they can be life threatening and require immediate medical attention.

Types of Fracture
Although there are three (3) classifications of a fracture, there are also many different types of fractures. These
are the three (3) more common types:
A complete fracture breaks clean through the bone, so that there are now two (2) parts.
Comminuted fractures result in more than two (2) parts to the bone. This can be a smashing of bone or simply
multiple fractures in the one (1) bone.
An incomplete fracture or greenstick fracture does not break the whole way through the bone, so that the bone
is still in one piece, but has a break in it.
Signs and Symptoms

There are many signs (what can be seen) and symptoms (what the casualty feels
or reports) of broken bones. These include:

hearing or feeling a break

hearing or feeling a grating of bone
pain
redness
loss of function
deformity
bone protruding from skin (open fracture).
Management

The main aims in the management of a fracture includes:

immobilise the area
reduce pain
prevent further damage
reduce bleeding and shock

Management requires the first aider to:

DRSABCD
control bleeding
cover wounds
check for other injuries
casualty remain still
immobilise fracture
handle gently
seek medical attention
Dislocation

A dislocation (or luxation) is when there is an abnormal separation in a joint

between two (2) bones.

A dislocated joint results in much damage to the surrounding soft tissues including:
sprains to ligaments and strains to muscles (particularly the rotator cuff muscles).

A dislocation is often caused by excessive force and can be either a direct

or indirect injury. Joints that frequently dislocate are those found in the fingers, and
ball and socket joints, such as the shoulder or hip.
Signs and Symptoms of Dislocation
There are many signs (what can be seen) and symptoms (what a casualty feels) of a dislocated
joint. These signs and symptoms include:
pain at the joint
swelling around the joint
bruising around the joint or just below the joint (gravity may cause the bruise to appear below
the ankle for example)
deformity of the joint
tenderness around the joint
inability to move the joint properly

Often these injuries are readily identifiable as the athlete often will clutch at the joint and allow the
rest of the limb to hang, or support their limb quickly to immobilise it. For example, a rugby player
who dislocates his shoulder will be seen holding his shoulder, while the arm hangs down or
supporting his elbow while bending over.
Management of Dislocation

Management of a dislocation requires:

DRSABCD
Do not move the joint
Check for circulation past the joint
Support the area
Apply ice packs
DO NOT try to relocate the dislocation.