"Two elbows on one arm?"

Without the aide of an x-ray machine you can rarely be sure if a bone is, or is not, broken. Sometimes an extremity will be angulated (or bent) in a very strange way. For example, the patient has two elbows. (And you think to yourself, "all patients have two elbows." Yes, but, THIS patient has two elbows on the same arm.) Or part of the patients femur (upper leg bone) is poking through the skin (yuk.) At times such as these, you can be certain that the bone is broken. However, these situations are uncommon when compared to the number of times that you encounter a possible broken bone. Therefore, it is our suggestion that you treat any suspected fracture as if it were broken. And, we suggest that you treat ANY painful swollen deformity as a suspected fracture.

When you encounter a patient with a painful swollen deformity, do not move the extremity from the position in which it was found. The patient will most likely remind you of this, if you try to move the extremity, because it will HURT, and they will not want it moved. The likelihood is very good that they will be "self-splinting" the extremity. This means that, if it is an arm that they have injured, they will be holding it close to their chest, or if it is a finger that they have injured, they will be "splinting" it against the adjacent finger, and probably holding it in a position that causes the least amount of pain.

There may be some bleeding associated with the broken bone, especially if the bone ends are protruding. In this case direct pressure should not be applied over the broken bone ends, or the site of the suspected broken bone. A clean bulky dressing** should be applied over the wound with little or no pressure. Do not elevate the extremity or move it excessively. If bleeding is very persistent, try applying a pressure point above (closer to the patient's body) the wound, but only if you have someone with you who can help stabilize the extremity.

At the first aid level, you really don't need to do anything more. You are not going to apply any make-shift or home-made splints, or cover any wounds with a bandage** (assuming, of course, that an ambulance is enroute.) Encourage the patient to hold the arm as still as possible, keep them calm and sitting in one place. Wait for the ambulance to arrive.

** -  It's important to understand, at this point (to help avoid confusion) that there is a distinction between a "dressing" and a "bandage."   A "dressing" covers a wound, and a bandage holds a dressing in place.

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