how do you know is a broken bone???

TazziRN, RN · Jul 23, 2007

If a break is suspected....even suspected......movement should not be attempted. Without an obvious angulation of the bone the only way to tell is with an x-ray. And it's very possible to have a break and still be able to move an extremity, especially in kids. The right thing to do would have to been to immobilize his arm and get him medical help.

woody62, RN · Jul 23, 2007

If you suspect a fracture, never ask the individual to attempt to move the area in question. It should be immobilized and the individual taken to the ER. X-rays are the defining tool in fractures.

Woody:balloons:

Beggar♂ · Jul 23, 2007

If it were my kid, here would be my thinking:

1) Going down on grass is unlikely to produce a fracture of an arm, especially in a kid. Turf is pretty soft. Fractures usually result from either striking a hard surface, twisting the bone, or leveraging the bone against a fulcrum.

2) Under those circumstances, a dislocation or hyperextension would be more likely than a fracture.

3) What I'd do is to immobilize the joint (you said pain in the elbow, right?), ice it, elevate it, and see how things progress.

4) If it persisted or got worse, I'd consider taking junior in for an X-ray through a clinic. Definitely not through the ER.

The mechanism of injury (kid falling on turf) just doesn't make my mind leap to "fracture" despite junior's assertion of a broken arm. More likely just an "oweee" or perhaps a sprain/strain.

TrudyRN · Jul 23, 2007

First off, you are probably NOT OBLIGATED LEGALLY to do anything to help. Check with a couple of attorneys in your state to be sure, as some states DO require medical personnel to assist and some DO NOT. Find out for your own state what the law really requires. Good Samaritan Laws help protect those who VOLUNTEER in an emergency. I'm not getting into the ethics of helping, only speaking legally here.

Secondly, there is no way to be sure a bone is broken unless it is a compound fracture and bone is actually poking through the skin or an X ray is done.

I have seen breaks that were accompanied by absolutely no swelling, I have seen severe swelling of an ankle that I was certain was broken but was not, as shown later on X ray.

It's like a sore throat. There is no way to be positive that it is a streptococcal infection, therefore an infection that requires an antibiotic, unless you do a culture. I have seen throats I thought were viral or allergic that turned up + strep. I have seen throats that I "knew" were strep that cultured negative.

Don't ever let anyone tell you otherwise - the only way to know for sure is to do the testing, be it culture or X ray, as indicated by the history and pt's c/o.

That said, it still might be ok to wait and see if pain subsides and motion returns. Then, the question of whether or not a break is present becomes moot.

Do NOT give advice to people unless you are advising them to see a doctor, go to an ER. Do NOT ever say you don't think they need to see a doc or get an ER evaluation. You must, to keep yourself out of a whole ton of woes, err on the side of caution. Even if you don't think the person really needs to be seen, you must protect your license and your house, car, investments, pension, IRA, etc. So do NOT EVER advise ANYONE, including your family members and your best friend to not see a doc.

Sad but true. And safe.

CRNA2BKY · Jul 25, 2007

First off, you are probably NOT OBLIGATED LEGALLY to do anything to help. Check with a couple of attorneys in your state to be sure, as some states DO require medical personnel to assist and some DO NOT. Find out for your own state what the law really requires. Good Samaritan Laws help protect those who VOLUNTEER in an emergency. I'm not getting into the ethics of helping, only speaking legally here.
Secondly, there is no way to be sure a bone is broken unless it is a compound fracture and bone is actually poking through the skin or an X ray is done.
I have seen breaks that were accompanied by absolutely no swelling, I have seen severe swelling of an ankle that I was certain was broken but was not, as shown later on X ray.
It's like a sore throat. There is no way to be positive that it is a streptococcal infection, therefore an infection that requires an antibiotic, unless you do a culture. I have seen throats I thought were viral or allergic that turned up + strep. I have seen throats that I "knew" were strep that cultured negative.
Don't ever let anyone tell you otherwise - the only way to know for sure is to do the testing, be it culture or X ray, as indicated by the history and pt's c/o.
That said, it still might be ok to wait and see if pain subsides and motion returns. Then, the question of whether or not a break is present becomes moot.
Do NOT give advice to people unless you are advising them to see a doctor, go to an ER. Do NOT ever say you don't think they need to see a doc or get an ER evaluation. You must, to keep yourself out of a whole ton of woes, err on the side of caution. Even if you don't think the person really needs to be seen, you must protect your license and your house, car, investments, pension, IRA, etc. So do NOT EVER advise ANYONE, including your family members and your best friend to not see a doc.
Sad but true. And safe.

Overall, good advice. I slightly disagree that the only break that you can confirm without an x-ray is a compound fracture. I witnessed a girl fall off a bench at a baseball game...and when she stood up, it was very, very, very clear that she had multiple fractures in her arm. It was a twisted mess, and her arm was twisted like someone had smashed it up with a baseball bat. It looked horrible. All from falling off a bench that all of 24 inches off the ground. BUT, it was NOT a compound fracture. She had broken both her ulna and radius, and in total, there were 3 different fractures, but none were compound. That said, most fractures do need to be diagnosed or confirmed via x-ray.

Also, if you want to save your car, house, and all your other possessions from legal action, put everything is separtate corporations, and hold nothing in your own name. That way, if they sue you, your possessions have a great deal of protection from the corporate veil. For instance, even though on the outside, it would look like my father had lots of money because of all the boats, houses, and cars that we had, he actually never owned anything. If he got sued, they could certainly take away his possessions, but since he didn't actually own much of anything, they couldn't get very much from him. Seek good legal council for good asset protection. There really are a lot of things you can do to protect your assets. Again, seek legal council for good advice on this important subject. Many people don't realize they can protect their assets.

luvmy3kids · Jul 25, 2007

My daughter had a friend (attempt) to sleep over on the last day of kindergarten. We have a Rainbow play structure in our back yard and the girls where swinging and playing on it. I went in to check on the pizza and minutes later my daughter comes running in to tell me her friend fell off the swing set and was crying.

When I went out there she was laying on the ground holding her arm and crying. I helped her up and brought her into the house. She couldn't move her arm AT ALL. I didn't ask her to, of course, but it was obvious that she couldn't even try. Her elbow gradually got bigger and bigger. Her mom took her into the ER and she had chipped the end of it right off. She had to have pins put in and a cast and the whole bit.

I was mortified. Apparently she had gotten on top of the monkey bars and tried climbing across them when she fell. Of course, I missed the whole thing.

Anyway... I just wanted to add in this case, it was pretty clear that it was broken because of the way she was treating it. Little kids are pretty durable. If it's not broken, most likely they will dust themselves off and be on their way.

It was cute too because it was her left arm (and she was right handed)... she said, "Well, at least it's not my good arm"...