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Updated 25 February 2013

Sprains, strains, fractures and dislocations

Learn what to do to treat sprains, strains, fractures and dislocations.

1

A sprain occurs when the ligaments around a joint are overstretched or tear. This is often due to a sudden wrench or twist which causes the bones of a joint to separate unduly. Sprains of the ankle, knee and wrists are common.

A strain (a "pulled" muscle) occurs when there is a sudden and excessive force on muscles or tendons, causing them to tear. This might happen with a fall, or when lifting something incorrectly. Strains of the lower back, neck and legs are common.

A fracture is a crack or a break in the bone, due to a heavy blow or sudden twist or wrench. In open fractures, the bones pierce the skin; in closed fractures, the skin is not broken.

A dislocation occurs when bones slip out of their proper alignment in a joint.

It may be difficult to distinguish between these four types of injury. They may all be present in one single injury. Symptoms for all of them are similar: pain, swelling and some bruising. Movement will be difficult and painful and there might be a deformity. A pop, snap or tear is sometimes felt or heard when the injury occurs.

Home treatment

For sprains and strains
Minor sprains and strains can be treated at home using the following measures. Start treatment as soon as possible to reduce swelling and speed up recovery. The less swelling, the more blood can get to the injured part to start the repair process.

  • Apply the R.I.C.E. method (see below).
  • Do not apply heat during the first two days as this will only increase swelling.
  • Use paracetamol for the first day of the injury, since it will reduce pain without increasing bleeding. Thereafter, ibuprofen (or other nonsteroidal antiinflammatories) or aspirin is a good choice. Don't give aspirin to a child younger than 16 years.
  • Arnica oil works well to reduce swelling.
  • Remove rings immediately if the injury is to the hand or fingers.
  • After 48 hours, start moving the limb gently, but only enough not to cause pain.
  • Gradually increase the range of movement – let pain be your guide.

Strains usually heal in about a week. Sprains may take up to three weeks to heal.

For fractures

  • Apply the R.I.C.E method.
  • Keep the limb in the position you found it and place soft padding around the broken bones. Splint the injury with something rigid, such as rolled up newspaper or magazines, to prevent the bones from shifting. Don't move the broken bones. Splints must be long enough to extend beyond joints above and below the fracture.
  • If there is an open fracture, cover it with a clean gauze pad. Apply pressure to control bleeding. Don't try to push the bone back into the wound and don't attempt to clean it.
  • Get medical attention immediately. Fractures of the femur and pelvis may cause severe internal bleeding.
  • Don't give the person anything to eat or drink in case surgery is needed.

See a doctor if:

  • You suspect a fracture or dislocation or if you are unsure of the severity of a sprain or strain.
  • You cannot straighten the affected joint or bear weight on it, or if a joint feels unstable.
  • The skin over the injury area is broken
  • The limb below the injury feels numb or tingling, or is white, pale or blue in colour, or feels colder compared to the other healthy limb.
  • The ligaments of the knee are injured.
  • You injure an area that has been injured several times before.
  • Pain is severe or lasts longer than 24 hours, or if swelling doesn't subside within 48 hours.
  • A sprain or strain doesn't improve after five to seven days.
  • Signs of infection develop.

Prevention

  • Many exercise-induced injuries can be prevented. Don't be a "weekend warrior". Get yourself into shape gradually with a graded exercise programme. Listen to your body. Warm up properly and cool off after exercising. Use proper equipment and the correct technique.
  • Use common sense to prevent injury in everyday life. Don't carry heavy objects. Watch where you step. Keep your home safe.
  • To prevent falls, older adults should keep their muscles strong by exercising or doing tai chi.

R.I.C.E method

  • Rest the injured part, especially for the first 24 to 48 hours after the injury – this is the most critical time of treatment. Avoid any activity that causes pain or makes it worse. Use crutches if the leg, foot or ankle is injured. Support an injured wrist, arm or shoulder with a sling. Tape an injured toe or finger to its healthy neighbour.
  • Ice is an excellent anti-inflammatory and reduces swelling and pain. Apply an ice pack or cold compresses for 10 to 15 minutes as soon as possible after an injury. Repeat each hour for the first 3 or 4 hours, then 4 times a day for the next 2 to 3 days. Protect your skin with a thin cloth. If ice packs are not available, a packet of frozen vegetables in a cloth will do.
  • Compression also reduces swelling. Use elastic bandages for at least 2 days. Check that the bandage is snug, but not too tight. Take the bandage off at night.
  • Elevation drains fluids from injured tissues. Elevate the injured area whenever you are sitting or lying down. Try to keep the injured area at or above the level of the heart.

    (Liesel Powell, Health24, June 2005)
 
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