"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

Master Medical Shopping List

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[1] Joseph Alton, The Survival Medicine Handbook, 349. 

[2] Survival and Austere Medicine, 3^rd Edition, 173.

[3] Joseph Alton, The Survival Medicine Handbook, 349. 

[4] Joseph Alton, The Survival Medicine Handbook, 349. 

[5] Survival and Austere Medicine, 3^rd Edition, 173.

[6] Survival and Austere Medicine, 3^rd Edition, 173.

[7] Rajendra Kumar Misurya, et al., “Use of Tuning Fork in Diagnostic Auscultation of Fractures,” Injury, January 1987, Vol 18 No 1, https://www.sciencedirect.com/science/article/abs/pii/0020138387903913 (accessed 2 February 2021).

[8] Brett A. Matzek, et al., “Novel Approach to the Diagnosis of Fractures in an Austere Environment Using a Stethoscope and a Cellular Phone,” Wilderness and Environmental Medicine, 2014, Vol 25, https://www.wemjournal.org/article/S1080-6032(13)00261-5/pdf (accessed 2 February 2021).

 

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