Description
A sprain occurs when the ligaments which hold the bones together around a joint are damaged (partially torn) by overstretching or twisting.

A strain occurs when a muscle or tendon is damaged by overstretching or an excessive contraction and is also partially torn or “pulled”.

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A fracture is a broken bone. There are two types of fractures: closed fractures, in which the skin is not broken, and open fractures in which sharp bony ends have caused a wound to the overlying skin.

A dislocation happens when one end of a joint is moved out of its normal position.

The most commonly injured tissues with sprains and strains are the ankle and knee ligaments, the leg muscles, the lower back, the wrist and the shoulders.

Arm injuries
Fractures can occur at the wrist, around the elbow or around the shoulder. Ligaments of the wrist, shoulder and elbow joints can be strained or sprained.

Sprains and strains in the wrist are common. The bones in the wrist can be fractured. Tennis elbow is the most frequent elbow injury. Partial dislocation of the elbow joint is common in children under five as a result of adults pulling on the arm.

A fractured collarbone and shoulder separation are the most common injuries in the shoulder area.

Ankle injuries
Sprains, strains and fractures of the ankle are common injuries when the ankle is twisted.

Knee injuries
Ligaments of the knee may be sprained or strained. Torn ligaments in this area need to be repaired surgically. Fractures in the knee area are uncommon.

Signs
Tissues that are sprained or strained become swollen and enflamed, are painful and will present with bruising around the affected area. Movement of the injured tissues will be painful; for example, if you have strained your calf muscle, walking on the injured leg will be painful.

It can be difficult to distinguish a fracture from sprains or strains as all three injuries can present with the same symptoms. It can be particularly difficult in children because their ligaments and tendons are stronger than their bones and the bones usually break before the ligaments snap.

Signs of a serious fracture include obvious deformity of the affected area, rapid swelling and inability to move and use the injured limb. A broken collarbone should be suspected if the arm on the affected side cannot be raised and the shoulders appear uneven.

A dislocation should be suspected if there is deformity and an inability to move the joint.

Get help immediately if:

• you suspect that the neck or back is injured
• there is an open fracture
• the limb is white, clammy or cold below the injured area
• the person shows signs of shock: paleness, dizziness, thirst and sweating
• the pelvis or thighbone might be broken

Home treatment
NOTE: If you suspect that the neck or back are involved, do not move the person unless there is imminent danger from, for example, traffic, fire or water. Movement can cause spinal cord or nerve damage if the underlying injury is severe. If the person must be moved, then there should be one person controlling the neck and head to keep them in alignment, and at least two people on either side of the person to lift while supporting the spine.

Splint the injured limb if you suspect a fracture, to keep the bone from shifting. Use something rigid – rolled up newspaper or magazines are effective if nothing else is available. Splints must be long enough to extend beyond joints above and below the area of the break.

If there is an open fracture, apply pressure on the area with a clean gauze pad or other clean material to control bleeding. Do not try to push the bone back into the wound and do not try to clean it.

Basic first aid for soft tissue and bone injuries includes:

Rest for the injured part of the body. Use crutches if the leg, foot or ankle is injured. Support an injured wrist, arm or shoulder with a sling. An injured finger can be rested by taping it to the healthy finger next to it (the same applies to toes). A broken leg can be tied to the other leg.

Ice packs or cold compresses applied for 20 minutes a time every few hours in the first two to three days to lessen the swelling and reduce pain.

Compression bandages for at least two days, also to reduce swelling. Don't wrap the injured area too tightly – loosen the bandage if the area feels cool or numb or if it tingles.

Elevation of the injured area above the level of the heart as much as possible. This also reduces swelling and bleeding.

Do not apply heat during the first week as this will only increase the pain and swelling.

Painkillers such as paracetamol or aspirin can be used. However, don't give aspirin to a child younger than 16 years.

Call a doctor if:

• you suspect a fracture or dislocation.
• the ligaments of the knee are injured.
• there are signs of nerve or blood vessel damage: 'pins and needles'; pale or blue skin that feels colder than an area of the limb that is not injured; inability to move the limb due to weakness.
• sprain is still symptomatic after six weeks.
• pain is severe or lasts longer than 24 hours.

(Reviewed by Dr Elmin Steyn, general surgeon)

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