“Is It Broken?” Differentiating Between Sprains and Fractures in an Austere Environment

Some fractures are going to be obvious—a bone is sticking
through the skin or there’s an obvious zig-zag where there shouldn’t be.  However, without technology, and without formal
education in medicine, we’re going to have a hard time differentiating between some
sprains and fractures.  Knowing (or, like
Dr. House, being able to make a really good guess) will reassure a patient and
help us provide better and more appropriate care.

Here are a few tips for identifying a suspected fracture: 

Pain.  Generally, a fracture is so painful that no
traction or pressure may be applied.[3]

Grinding.  In addition to the pain, the patient may
report a grinding sensation when it is pressed, as if the two (or more) ends
are rubbing against one another.[4]

Deformity.  Compare the injured body part with its
counterpart, i.e, compare the injured wrist with its non-injured mate.  Do you see any differences in length or
structure?[5]

Longitudinal force.  Apply longitudinal force along the bone—compress
the two ends of the bone together, like you are trying to collapse or shorten
the bone.  Such an attempt will be
painful if the bone is fractured.[6]  

Swelling.  A fracture usually exhibits more pronounced
welling and bruising.[1]  (If the swelling goes down, if the joint is
working and not overly painful within 7-10 days, it was probably a sprain.  On the other hand, if it is still swollen,
still significantly painful or impossible to use after 7-10 days, it’s probably
a fracture.[2]) 

Sound conduction 1.  Use a tuning fork and stethoscope.  The tuning fork is tapped against a hard
surface to start the vibrations and then applied to the distal end of the bone
with a suspected fracture.  The
stethoscope is applied to the proximal end of the bone with the suspected
fracture.  A fracture in the bone will
reduce or completely eliminate the conduction of sound by the bone.  It allows for quick examination of a patient
without causing pain and works even in unconscious patients.  And it is a simple test to conduct, even for
non-medical personnel.  Studies showed
that this test is 94% reliable, whereas conventional clinical diagnosis was
only correct in 88% of cases.[7]

Sound conduction 2.  Use a cell phone and a stethoscope.  The idea to use the vibrate function of a
cell phone and a stethoscope evolved from the use of the tuning fork, with the
object of reducing the amount of equipment medical providers need to
carry.  A tuning fork, while useful for
identifying fractures, doesn’t have many other applications.  However, many people carry cell phones.  Anyway, just like with a tuning fork, the
cell phone (cover removed) is applied to the distal end of the bone.  The stethoscope is applied to the proximal
end.  A noticeable decrease in the sound
propagation suggests a fracture in the bone.[8]

These methods will help differentiate between sprains and
fractures so that you can provide appropriate care.  Future posts will cover specific bone
fractures and treatment.

Links to related
posts:

Ankle Sprains and Fractures (next week)

Master Medical Shopping List