Fractures and Joints


A fracture is a break or crack in the bone. Generally considerable force is required to break a bone, but old or diseased bones become easily breakable. Conversely, young bones that are still growing are supple and may split, bend or crack rather than break. Any type of fracture may be associated with an open wound and complicated by damage to other structures. There are three main types:

Simple Fracture:This is simply a clean break or crack in the bone.

Comminuted Fracture:This term is applied to a fracture with multiple bone fragments.

Greenstick Fracture: A split in a young, immature bone, common in children.

Fractures can also be classified as open or closed. Open, or compound, fractures are accompanied by a wound. The overlying skin is broken and the bone may be exposed to contamination from the skin surface and air. When the skin around a fracture is intact the injury is known as a closed fracture. There will often be bruising and swelling. It should also be noted that a bone may break distant to the point of impact.


In some cases, broken bones will be obvious; the limb may be bent at an impossible angle or the bone may have torn through the skin. In other cases, the injury may appear to be a severe sprain. A broken bone may usually be differentiated from a severe sprain by limitations in mobility, or in the case of hand or wrist injuries, the inability to grip effectively with the affected hand. If the skin has not been broken, the limb should be straightened and returned to its normal configuration, splinted securely, elevating the limb as much as is comfortable and possible. In some cases, such as broken ribs, this is obviously not possible. However, an attempt should be made to prevent motion of the bone as much as possible. Treat for internal bleeding.

If the skin has been broken, the wound should be treated carefully. First control the bleeding. Once you have that stopped, immobilize the bone as much as possible, elevate it and cleanse the wound with redwort, as the risk of infection is great. Numb the wound thoroughly and then make your assessment. It may be that you can manipulate the bone, stitch the wound and splint it.
Some fractures may required amputation, with some resulting in paralysis and others in death. It should be noted that fractures to the femur are serious and may result in substantial bleeding.


Displacement of a bone at a joint can be caused by a strong force wrenching the bone into an abnormal position or by violent muscle contractions. There may be associated tearing of the ligaments. Those joints most often affected include the shoulder, thumb, finger and jaw. It can be difficult to distinguish a dislocation from a fracture.
Dislocations are usually differentiated from fractures by severe and 'sickening' pain rather than tenderness over the bone. As this can be considerably painful you should first administer Fellis. Then maneuver the joint back into its socket, treat for soft tissue swelling (soft tissue injuries) and immobilize it.

Soft Tissue Injuries

These are injuries that affect the ligaments and muscles. A sprain is an injury to a ligament at, or near, a joint, and is most frequently caused by a wrenching movement at the joint that tears the surrounding tissues. Muscles and their tendons may be overstretched and torn by violent or sudden movement. Muscle damage can occur in one of three ways:


A partial tearing of the muscle, often at the junction of the muscle and the tendons that joins it to a bone.


Complete tearing of the muscle, which may occur in the fleshy part or in the tendon.

Deep Bruising

This may be extensive where there is a large bulk of muscle.


Sprains, strains and deep bruising are very common, especially amongst dragonriders. They are all treatable by following the 'RICE' procedure:

R est the injured part
I Apply ice or a cold compress
C Compress the injury
E Elevate the injured part

The affected area should be immobilized as much as possible. In some cases, a light wrapping with bandages will be enough to accomplish this; in others splinting may be required. Leg and ankle injuries may require the patient to get around with crutches for a few days. The patient should be cautioned to use care when resuming normal activities, as the injured area will be weak and may be more prone to reinjury for several sevendays. More serious injuries may cripple the patient unless some interventive surgery is performed.

Other Joint Conditions


Joints may become affected by inflammatory or degenerative changes, which will cause pain and stiffness of the joints described as arthritis. The age of onset differs in each individual, but generally it can be recognized by swelling and deformity of the joint, with pain and limitation of movement. There is little treatment available, apart from diagnosing pain relief for the joint area, usually a topical application of numbweed. However, fish liver oil and yellow citrus oil have been showed to allay the symptoms if taken regularly.


Pain in the back can be caused by muscular strains, 'slipped' disks or from a disease of the bones and joints. Most commonly it is caused by strain of the muscles surrounding the back. This condition should be treated with rest and gentle movements, where the patient should be advised to keep their back straight. An application of numbweed and massage of the area may also help. 'Slipped' disks should also be treated with bed rest. Rest should be proscribed for two sevendays, sometimes more. This often allows the protrusion to be reabsorbed back into the disk and the damaged capsule to heal. If symptoms do not improve with simple rest, you may apply traction using weights to pull the vertebrae apart and so promoting return of the disk to its normal position. Patients should be warned that there is a likelihood of recurrence and exercise and correct posture is necessary to prevent this. Another common cause of backache is the minor displacement of the many small joints between the vertebra. Manipulation of the spine can encourage the spine to return to its natural alignment, as can gentle massage.


Bunions are unsightly deformities of the joint at the base of the big toe. The site is likely to be tender, swollen and pus may be present. Strapping, splinting and attention to wearing comfortable shoes/boots many improve matters by reducing pressure. However, other than relief there is no treatment.


Gout is a defect in the blood which causes the accumulation of waste products. Symptoms are usually sudden, affecting a single joint. It can be extremely painful, so much so that the patient may not be able to bear the weight of a sheet over the area. There is usually heat, swelling, redness and excruciating pain and tenderness. After the first attack more can be expected within a turn if no treatment if forthcoming. Patients benefit from the application of anti-inflammatory agents, such as chamomile. Basil has some benefits, as has the application of numbweed to reduce pain.

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