Fractures, sprains and injuries to the musculoskeletal system

Fall from a stair, a twist in the ankle on uneven pavement, or a blow to the arm — injuries to bones, joints, and ligaments are among the most frequent you meet as first aider. Some are harmless and heal on their own, others require you to act right to not make the injury worse. Common to all is that you rarely can see with the naked eye whether it's a fracture or 'just' a sprain — and therefore in case of doubt you always treat the worst scenario.

§Is it a fracture or a sprain?

A fracture is damage to the bone itself while a sprain is damage to the ligaments around a joint — they are stretched or torn typically after a twist. Both can cause swelling bruising and severe pain and they can look very similar in the first minutes. Signs pointing more towards a fracture are an obvious misalignment of the limb a crunching sound or feeling at the injury or that the person cannot use or bear weight on the body part at all.

• 01Severe pain that worsens with movement or load
• 02Swelling and bruises around the injury
• 03Visible misalignment or unnatural angle on an arm or leg
• 04Reduced or absent function — the person cannot use the body part normally
• 05For open fractures: the bone is seen through the skin or there is a deep wound at the fracture

§Basic rule: treat it as a fracture

If you are in doubt, any injury to an arm or leg should be treated as if it is a fracture until clarified at the emergency room. This means that you support and stabilise the body part in the position you found it in, rather than trying to straighten it out or testing how much it hurts. The purpose is to prevent a fracture from moving and damaging nerves, blood vessels or surrounding tissue further.

§The RICE principle for sprains and strains

For minor serious injuries to ligaments and muscles — sprains and strains — Danish First Aid Council recommends the RICE principle as first handling. The four letters are a mnemonic for the sequence of what you do.

• 01Rest (immobilization) — stop stressing the injured joint immediately
• 02Ice (ice/cooling) — cool the area to reduce swelling and pain
• 03Compression (compression) — apply a light elastic bandage around the joint
• 04Elevation (high bed) — hold the injured body part high to reduce swelling.

§How to support an injury (immobilization)

That immobilizing means keeping the injured body part at rest so it doesn't move during transport or while waiting for help. An arm can often be supported against the body with a triangular bandage or scarf as a sling, while a leg can be carefully supported with blankets or pillows on both sides so it doesn't roll or twist. Splints and more advanced equipment belong in a first aid course or with ambulance personnel — but the principle of supporting rather than moving unnecessarily always applies.

§Suspected back or neck injury

For falls from height powerful collisions or accidents where the person complains of numbness, tingling or lack of strength in arms or legs you should suspect damage to the back or neck. A different rule applies than usual: do not move the person unless there is acute immediate danger such as fire or traffic. Ask the person to lie completely still support the head if necessary with your hands to avoid movement and wait for ambulance personnel who have equipment and training to move the person safely.

§When should you call 1-1-2

• 01For open fractures where the bone is seen or there is heavy bleeding
• 02For clear misalignment of an arm or leg
• 03For suspected back neck or head injury
• 04If the person cannot use the body part, is in great pain or is in shock
• 05If you are in doubt — it is always better to get an assessment for too much than too little

“You must not make a diagnosis at the accident scene. Your task is to support, keep calm, and get the right help in place.”

— Basic first aid rule