Practice Preps - Bones

[Mother]

There is no doctor or medical facility available and you or a member of your family has sustained what appears to be a broken bone.

 

How do you assess the injury and what would you do to treat various situations, simple fracture, compound fracture, green break, etc.?

 

 

 

 

 

 

[Screaming Eagle]

Okay, Mom, now you've done it. You've tapped into one of the subjects near and dear to my heart. That being the wonderful intricacy with which our Creator has made our bodies. I've been holding off on making this post in particular because the answer is so much bigger than the question. Forgive me if I get into a 'teaching' mode but I think it's so very important to get the 'principle' underlying the thinking that will be necessary to get to the core of wisdom in answering and properly dealing with this problem. Might be too much detail for some folks but it's something that will be here for reference for all of us as long as we have access to this site.

First, a few websites about basic anatomy and structure of bones in particular. Might be a useful resource for homeschoolers also.

http://www.innerbody.com/htm/body.html

http://encarta.msn.com/encyclopedia_761563..._(anatomy).html

http://www.rush.edu/rumc/page-1098987406902.html

 

As you can see, the periosteum is made of hard compact tissue (what we ordinarily think of as bone) and 'cancellous' tissue which is spongy and makes up the inside of bones. Bones are living 'things' that have blood flowing through them and have functions much more complicated than just support for our fleshly bodies. That old spiritual song 'dem bones, dem bones' referring to Ez 37:1-14 in which Holy Spirit breathes on dry bones to bring them back to life is just ringing in my head right now.

When that flow of blood is broken, it disrupts the life of the blood flowing through very small pathways that keep the bone healthy and producing all sorts of necessary things for our body. They're constantly being changed according to our intake of calcium, phosphorus, iron etc and it's all in a very delicate balance.

Now to answer at least some of your (rather profound whether you know it or not) question. Essentially, when the periosteum (hard outside plus spongy inside) is 'broken' or severely disrupted, the chances of getting it back to functioning properly are signficantly diminished. Most severe bone injuries before the last 75 years or so resulted in amputation. To take your question and scenario literally, that would likely be the case regardless of what we did in a full SHTF situation. Makes amputation skills a literal life-saving ability. Not good news for any of us, but without adequate medical intervention, that's what would inevitably happen with complete and certainly with multiple breaks. Below the knee or below the elbow would be a blessing if accomplished correctly because the person would survive even if maimed significantly. Sorry to have to say that, but that's just how serious things could get.

Simple fracture means that the skin is not broken. Bruised and swollen but difficult if not impossible to tell if a bone is broken or not just from looking. Best thought of as a 'closed' fracture. Compound fracture means that the skin is broken and the bone is probably protruding...a clear break. Tissue is probably damaged around the bone (nerves, blood vessels, muscle, cartilage). Fractures are also classified as complete or incomplete. Complete means that the bone is broken completely in at least two parts. Incomplete means that the bone is significantly damaged/broken but not separated into two distinct pieces. Single break means that it's at only one point while multiple indicates that it's broken in more than one place. Linear means that it's broken in line with the bone while transverse means that it's broken across the bone. A 'green stick' fracture means that the bone is partially broken (think of a green stick that you bend until it breaks on one side) that could heal if treated. Children and adolescents in the process of growth could also have the 'growth plates' broken which would disrupt further growth. You asked specifically about assessment so there it is.

Setting bones in the Western medical tradition is very different from the way it's handled in Eastern medical philosophy. This

 

http://www.hinduonnet.com/folio/fo0010/00100380.htm

 

is a link to a Chinese description of some of their recommended ways of treating fractures without traction, casts and de-mobilizing that might be appropriate in desperate situations. Worth taking a look at and has some relatively clear drawings and descriptions that might be worth filing away as reference.

Hope this helps. It will probably raise more questions than providing answers but that's what learning new skills is all about. Lemme know if you want more info from me.

 

 

[CrabGrassAcres]

Something they didn't teach in nursing school, but that I've picked up by observation. Frequently people with a broken bone will exhibit abnormal psychological states while the bone is healing. They are frequently short tempered and may even become delusional. If you are treating someone with a bone break in an emergency situation you need to be aware of this and alert that the person may act totally different than their normal selves. They may even place themselves and others in danger. This is transient and the person will return to a normal mental state once the bone is healed.

[Screaming Eagle]

CGA, That makes sense in a number of ways. Mainly, what I'm thinking is that there is a significant chemical disruption that throws the entire system out of balance as the body is scrambling to repair and address the imbalances. Some of these disruptions are at the hormonal level including thyroid etc. Small (ppb) changes in that hormone in particular can literally make people psychotic until the balance is restored. I've taken care of little old ladies that broke a hip or something who are essentially whacked out and confused for weeks sometimes. Add some of the confusion that comes from pain meds as well as compromised cardiac status and you've got a very real potential mess on your hands unless we look at it as a 'whole' system being thrown off kilter. Then there's that 'minor' part of that individuals makeup spiritually and psychologically as well as past experiences with pain etc that add another whole dimension to it.

[PureCajunSunshine]

Originally Posted By: Screaming Eagle

Forgive me if I get into a 'teaching' mode but I think it's so very important to get the 'principle' underlying the thinking that will be necessary to get to the core of wisdom in answering and properly dealing with this problem.

This is part of what makes you such a gifted teacher. We are so blessed!

Understanding the 'nuts and bolts' of a problem is so important, and is better than performing a procedure without knowing why it works that way.

This kind of knowledge may come in handy if any of us should ever have to resort to 'making do' with less than ideal supplies or conditions.

Thank you for being here, Screaming Eagle.

[Mother]

SE, Thank you for that reply and for the others you've been posting. These are the types of posts that help others be better prepared. Please feel free to add whatever you feel pertinent here.

 

I especially enjoyed the Hindu website. I'm always amazed that our "modern" medicine thinks it's so advanced yet for centuries other countries have been way out ahead of us. Not only do most of those countries have extremely advanced medicine they also encompass much of the ancient ways yet. We would do well here to intergrate our own historic medicines with our modern ones as well.

 

If I had a broken bone in normal times I would certainly not hesitate to see a medical doctor but if no doctor or facility were available to me I wouldn't hesitate to attempt to repair it myself, what else could a person do. I've had some experience with broken bones in wild life and would not hesitate to translate that knowledge to humans with the exception of the experience I've had with birds. The majority of their bones are hollow.

 

I am curious what red powdered herb the Hindu's used on their wounds. I couldn't find an answer in my quick read. I'll have to check further into it. That or a similar herb might be a good one to stock or grow.

 

Again, thanks. I'm really enjoying all the replies. We have some very talented members here and I'm grateful they do not hesitate to post their thoughts and knowledge.

 

((( )))

[Mt_Rider]

One of the ways that someone can triage bone breaks is with a tuning fork. If a break is suspected, they touch a (lower note) tuning fork (after setting it vibrating) on the suspected area of break. If the problem is a sprain/strain...muscles rather than bone...the vibrations of the tuning fork do nothing. But if there is bone break, the vibrations will cause the bone ends to vibrate with each other and.....the patient will wish to kill the person holding that tuning fork. It only takes a second but it HURTS. [Pain is one of our body's communication systems.] But it does not displace the bone like in the old cowboy movies when they'd wrench on the bone to "see if it's broke". Sooo, if one does not have Xray, this can at least give an indication.

 

I don't think it would distinguish between types of breaks. I wonder if this would matter much....in a time of no docs? Would we be treating all breaks the same - other than maybe length of immobility?

 

 

 

 

 

MtRider [ looking up 'boneset' , etc. ]

[Screaming Eagle]

I forgot one very quick and easy way to do a rudimentary assessment for breaks. Simply touch the area and feel for warmth. If it's warm and very tender, it's worth an x-ray if that's available. Worked so many times for me when I was the DON at a local Jail that I can't tell you. So many of those guys would try to wrangle a trip to the hospital just to get out that we had to have a quick down and dirty screen to weed out the malingerers (imagine that in a jail lol). Worked almost every time.

[Mother]

For Clovis

[Becca_Anne]

Awesome tips about the tuning fork and feeling for warmth!

And for Anatomy I would like to recommend everyone buy The Anatomy coloring book. It's very detailed and easy to understand. Also Netter's Anatomy flash cards. i'm currently taking A&P and those have helped me so much.

 

And if someone broke a bone I'd try to track down a Dr friend or our vet!!! I don't think I have near enough knowledge to try to do more than immobilize the limb. I have an inlatible leg splint on hand as well as a sling.

[Clovis]

Thank you mother for the bump.

 

I like the idea about the tuning fork. I'd never heard of anything like it.

 

I know the hormonal changes and pain can cause some of the mood changes, but I had to wonder too if part of it is just the non-ability to be as independent and self sufficient as the person would normally be. Evevn tho I've never had a broken bone (thank goodness), I know when I'm sick or down I'm grouchy and not thinking straight.

 

I had heard of feeling to see if the area is warm. My mother was a nurse for over 40 years and I've heard her talk about it many times and even use it on me a few when I was a kid.

[gimmeaminute]

This is a good thread, thanks.

[cookiejar]

Back twenty some odd years ago when I was in the military, the Nurse Pract. thought I had a kidney infection. She had me lay up on the exam table flat, face up. The Mil. Doc. walked in, lifted my foot and with no warning slammed the heel of his palm to the heel of my foot causing a huge vibration up my body and a scream heard in Canada. The pain was unreal.

 

The doc merely nodded and said to the goggled eyed NP,"Yup, Kidney infection, get her drugs".

 

I can still remember that vibration and pain. But it told him where it was because back pain can be so many things.(I think I'd have preferred a pee test...LOL).

[dogmom4]

Ds broke his finger Thursday. Made me wonder how I would have handled it with no doctor available.