Sprains and Suspected Fractures: First Aid

Sprain, strain or broken bone?

A sprain happens when the tough bands that hold a joint together are stretched or torn, most often in an ankle, knee, wrist or thumb. A strain affects a muscle or the cord that joins a muscle to bone. Both cause joint or muscle pain, swelling, stiffness and bruising, and both get the same first aid.

A broken bone can look very similar at first. The signs that point to a break are a limb or joint that looks out of shape or bent at an odd angle, swelling, bruising or bleeding, pain that may be severe, and not being able to move the part or put weight on it. You cannot reliably tell a sprain from a break by looking, so when you are unsure, treat it as a possible break and have it checked.

First aid for a sprain or strain

Follow these steps for the first 2 to 3 days after the injury.

1. Protect the injury. Use a support, or firm shoes, so the joint is not knocked again.
2. Rest. Stop the activity and try not to put any weight on the injured part.
3. Ice. Wrap ice or a bag of frozen peas in a thin cloth and hold it on the injury for up to 20 minutes, every 2 to 3 hours. Never put ice straight onto the skin.
4. Compress. Wrap a bandage around the area during the day to support it. Wrap firmly but not tightly.
5. Elevate. Keep the injured part raised on a pillow as much as you can, above the level of the heart where possible.

Loosen the bandage straight away if the fingers or toes beyond it tingle, go numb, turn pale or feel cold. A pharmacist can suggest suitable pain relief.

If you think a bone is broken

1. Keep the person still and calm, and check that they are awake and breathing normally.
2. If a bone has broken through the skin, cover the wound with a clean dressing without touching the wound or pressing on the bone.
3. Support the injured part in the position you found it, using a sling, padding or rolled cloth.
4. Hold a cloth-wrapped ice pack against the area, and raise the limb if you can without forcing it.
5. Take off rings, bangles or a watch from an injured arm before swelling sets in.
6. Do not give food or drink, in case an operation is needed. Arrange transport to hospital.

If the person turns pale, cold and clammy, lay them flat, raise their feet about 30 centimetres, and cover them with a blanket. Do not do this if you suspect a spine injury.

What not to do

• Do not place ice directly on bare skin.
• Do not try to straighten a bent limb or push a bone back under the skin.
• Do not test the injury by asking the person to move it or walk on it to see how bad it is.
• Do not move someone with a possible injury to the spine, hip, pelvis or upper leg unless they are in danger where they lie.
• Do not use heat, such as hot baths or heat packs, and avoid massage and alcohol, for the first couple of days.

When to get emergency help

Treat it as an emergency and call Rescue 1122 where available, or go to the nearest hospital emergency department if:

• you heard a crack at the moment of injury
• the limb or joint has changed shape or is pointing at an odd angle
• a bone is sticking out through the skin, or there is heavy bleeding
• the skin beyond the injury is numb, tingling, cold, pale, blue or grey
• the injury involves the head, neck, back, hip, pelvis or upper leg
• the person lost consciousness, or you cannot keep the injury still

Get medical advice the same day if the pain is severe or getting worse, there is a large or growing amount of swelling or bruising, you cannot take more than a few steps, the joint is stiff and hard to move, or you have a fever or other signs of infection, or home care has not helped after a few days.