Fracture first aid is about recognising a possible broken bone, keeping the casualty safe, supporting the injured area and preventing unnecessary movement while appropriate medical help is arranged.

A fracture is a break, crack or other disruption to a bone.

Some fractures are immediately obvious. Others can be difficult to distinguish from a serious sprain or other soft tissue injury.

You do not need to diagnose a fracture before providing first aid.

If the signs and mechanism of injury make you suspect a broken bone, treat the injury carefully and arrange appropriate medical assessment.

What Is a Fracture?

A fracture occurs when a bone is broken or cracked.

This can happen following:

a fall
a direct blow
a road traffic collision
a sporting injury
a crush injury
twisting or excessive force
a fall from height

Some medical conditions can also weaken bones and make fractures more likely.

The seriousness of a fracture depends on factors including which bone has been injured, the force involved and whether surrounding tissues, blood vessels, nerves or organs have also been damaged.

What Are the Signs of a Fracture?

Possible signs and symptoms include:

pain
tenderness
swelling
bruising
difficulty moving the injured area
inability to use or bear weight on the injured limb
an unusual position or shape
shortening, bending or twisting of a limb
a wound over the injury
bone visible through a wound

The casualty may also tell you that they felt or heard something crack or snap when the injury occurred.

However, the absence of an obvious deformity does not rule out a fracture.

Can You Tell Whether a Bone Is Broken?

Not always.

A fracture can sometimes look similar to:

a sprain
a strain
a dislocation
another soft tissue injury

You should not deliberately move the injured area to see whether it is broken.

Nor should you repeatedly press around the injury looking for a fracture.

If you suspect a significant injury, support it and arrange appropriate medical assessment.

An X-ray or other medical investigation may be needed to confirm the diagnosis.

Closed and Open Fractures

Fractures are commonly described as closed or open.

Closed Fracture

With a closed fracture, the skin over the broken bone remains intact.

There may still be considerable:

pain
swelling
bruising
internal bleeding
damage to surrounding tissues

A closed fracture can therefore still be a serious injury.

Open Fracture

An open fracture involves a wound that communicates with the broken bone.

The bone does not necessarily have to be visibly sticking out of the wound.

Open fractures are particularly serious because there is an increased risk of:

severe bleeding
infection
damage to surrounding structures

Open fractures need urgent medical treatment.

Fracture First Aid: What Should You Do?

If you suspect a fracture:

Check that the scene is safe.
Assess the casualty for more serious problems first.
Keep the injured area as still as possible.
Support the injury in the position you find it.
Control serious bleeding if present.
Cover an open wound appropriately.
Arrange appropriate medical help.
Monitor the casualty while waiting for help.

The exact response depends on the location and severity of the injury.

Check for More Serious Injuries First

A broken arm can look dramatic, but it may not be the casualty’s most serious problem.

Before concentrating entirely on the fracture, consider whether the casualty has:

a compromised airway
abnormal breathing
severe bleeding
reduced responsiveness
a serious head injury
a possible spinal injury
other life-threatening injuries

Deal with immediate threats to life first.

Our guide to scene safety in first aid explains why checking for danger and understanding what has happened should come before treating an individual injury.

Keep the Injury Still

Encourage the casualty not to move the injured area unnecessarily.

Movement can:

increase pain
worsen bleeding
increase damage to surrounding tissue
potentially affect nerves or blood vessels

Support the injured area with your hands if necessary until more suitable support is available.

Where possible, let the casualty remain in the position they find most comfortable.

Support the Injury in the Position Found

A useful principle in fracture first aid is to support the injury rather than trying to straighten it.

Do not attempt to:

push a bone back into position
straighten a deformed limb
force a joint into a normal position
push exposed bone back through a wound

These actions can cause further injury.

Support the limb above and below the injured area where practical.

Should You Use a Splint for a Fracture?

Splints can be useful in some circumstances, particularly when a casualty needs to be moved or when professional medical help will take a significant amount of time to arrive.

However, a first aider does not need to splint every suspected fracture.

Often the safest approach is simply to:

keep the casualty comfortable
support the injury
minimise movement
wait for professional help

Poorly applied splints can cause problems by:

increasing pain
moving the fracture unnecessarily
interfering with circulation
putting pressure on the injury

Do not improvise a complicated splint simply because you think every broken bone requires one.

What Can Be Used to Support an Injury?

Depending on the injury and circumstances, support might include:

the casualty’s own hand
the uninjured limb
pillows
folded clothing
blankets
padding
a sling
a purpose-made splint

The aim is to reduce unnecessary movement without creating additional pain or circulation problems.

How Do You Apply a Splint?

If splinting is appropriate and you have been trained to do it:

support the injury before applying the splint
avoid unnecessary movement
pad the splint where needed
secure it above and below the injury
avoid placing tight bandages directly over the fracture
check circulation beyond the injury
continue monitoring the casualty

A splint should support the injured area rather than force it into a different position.

If applying the splint significantly increases pain or compromises circulation, reassess what you are doing.

Check Circulation Before and After Supporting an Injury

A serious limb injury can affect circulation.

Where appropriate, look beyond the injury for signs such as:

unusually pale skin
blue or grey colour
coldness
numbness
tingling
inability to move fingers or toes normally

You can compare the injured side with the uninjured side.

If circulation appears compromised, this increases the urgency of medical assessment.

Do not repeatedly manipulate the limb in an attempt to restore circulation yourself.

What Should You Do with an Open Fracture?

An open fracture requires urgent medical treatment.

If there is a wound:

do not push exposed bone back inside
do not straighten the limb
control bleeding carefully
cover the wound with a sterile or clean dressing where available
support the injured area
arrange urgent medical help

If bone is protruding, place padding around the injury where possible rather than pressing directly onto the exposed bone.

What If an Open Fracture Is Bleeding Heavily?

Life-threatening bleeding takes priority.

Call 999 and control serious bleeding.

Apply pressure around the wound where necessary while avoiding direct pressure onto protruding bone.

Depending on the injury, location of the bleeding and your training, management of catastrophic limb bleeding may involve a tourniquet.

Our guide to severe bleeding first aid explains direct pressure, wound packing and tourniquets in more detail.

When Should You Call 999 for a Suspected Fracture?

Call 999 when the injury is serious or the casualty needs emergency assistance.

Examples include:

an open fracture
severe bleeding
a badly deformed limb
suspected fracture of the pelvis
suspected fracture involving the neck or spine
a serious head injury
a major road traffic collision
a significant fall from height
a crush injury
loss of sensation or circulation beyond the injury
the casualty being unable to move safely
signs of shock
multiple serious injuries

If you are unsure whether an ambulance is required, seek appropriate medical advice.

What About Less Serious Suspected Fractures?

Not every suspected fracture requires a 999 ambulance.

For an isolated injury where the casualty is otherwise well and can be transported safely, appropriate medical assessment may be arranged without using an emergency ambulance.

Depending on the circumstances, this might involve:

an urgent treatment centre
an emergency department
NHS 111 advice

Avoid unnecessary movement and support the injury during transport.

If the casualty’s condition deteriorates, call 999.

Fractures and Shock

A serious fracture can cause internal bleeding.

This is particularly important with injuries involving large bones or the pelvis.

Watch for signs that the casualty is becoming seriously unwell, such as:

pale or clammy skin
weakness
dizziness
rapid breathing
increasing anxiety or restlessness
reduced responsiveness

Keep the casualty still and call 999.

Do not give food or drink when serious injury or surgery may be a possibility unless instructed by a healthcare professional.

Suspected Pelvic Fractures

A pelvic fracture can be associated with significant internal bleeding and should be treated seriously.

It may follow:

a road traffic collision
a fall from height
a crush injury
significant trauma

The casualty may complain of pain around the:

pelvis
hips
groin
lower back

Do not repeatedly press or “spring” the pelvis to test whether it is broken.

Keep the casualty still, call 999 and follow the ambulance service’s instructions.

Suspected Spinal Fractures

A fracture involving the spine can potentially damage the spinal cord.

Consider spinal injury following mechanisms such as:

a serious road traffic collision
a significant fall
diving into shallow water
major sporting trauma
a heavy impact

Encourage the casualty to remain still.

Do not move them unnecessarily.

Call 999 when a serious spinal injury is suspected.

If the casualty develops an immediate airway or breathing problem, life-saving treatment takes priority.

Fractures and Head Injuries

Some incidents that cause fractures can also cause a head injury.

For example:

falls
road traffic collisions
sporting impacts
assaults

Do not become so focused on an injured arm or leg that you miss signs of a more serious head injury.

Our guide to head injury assessment explains the warning signs that need urgent medical attention.

Fractured Ribs

Rib fractures commonly cause:

localised chest pain
tenderness
pain when breathing deeply
pain when coughing or moving

Do not tightly strap or bandage the chest.

A serious chest injury can affect breathing or damage structures inside the chest.

Call 999 if the casualty develops:

significant difficulty breathing
worsening breathlessness
severe chest trauma
coughing up blood
reduced responsiveness
signs of shock

Fractured Collarbone

A fractured collarbone can happen after a fall onto the shoulder or outstretched hand.

The casualty may naturally support their injured arm.

Help them find a comfortable position and support the arm where appropriate.

A sling may help provide support, particularly if the casualty needs to travel for medical assessment.

Do not try to push the shoulder or collarbone back into position.

Arm and Wrist Fractures

Falls onto an outstretched hand commonly cause injuries to the:

wrist
forearm
elbow
upper arm

Support the limb in a comfortable position.

Remove rings, watches or other restrictive items early if this can be done easily because swelling may develop.

Do not force jewellery off if doing so would move or worsen the injury.

Leg and Ankle Fractures

If you suspect a fracture of the leg or ankle:

encourage the casualty not to stand
support the injured area
avoid unnecessary movement
arrange appropriate medical assessment

Do not ask someone to “try walking on it” simply to see whether the bone is broken.

Being able to move or even bear some weight does not reliably rule out a fracture.

Should You Remove a Shoe or Boot?

There is no need to routinely remove footwear from every suspected foot or ankle fracture.

Removing a tight shoe before significant swelling develops may sometimes be useful, but only if it can be done without causing unnecessary movement or pain.

Do not struggle to remove boots or footwear from a badly injured limb.

Leave difficult removal to healthcare professionals.

Fractures in Children

Children can sustain fractures from:

falls
sport
playground accidents
cycling
road traffic incidents
other trauma

Some childhood fractures can be less obvious because children’s bones differ from adult bones.

If a child has significant pain, swelling, deformity or refuses to use a limb following an injury, arrange medical assessment.

Do not force the child to move the injured area.

Support it in the position they find comfortable.

People caring for children can develop practical injury-management skills through Paediatric First Aid training.

Fractures in Older People

Falls can cause serious fractures in older people, particularly involving the:

hip
wrist
arm
pelvis

A person with a suspected hip fracture may have:

severe hip or groin pain
difficulty moving
inability to stand
a leg that appears shortened or turned

Do not attempt to get them back onto their feet.

Keep them comfortable, protect them from becoming cold and call 999 when a hip fracture is suspected.

Should You Apply Ice to a Suspected Fracture?

A wrapped cold pack may help reduce pain and swelling around some closed injuries.

Never place ice directly onto the skin.

However, cooling the injury is secondary to:

casualty assessment
controlling serious bleeding
supporting the fracture
arranging appropriate medical help

Do not allow applying an ice pack to delay more important treatment.

Should You Give Painkillers?

First aiders should work within their training and organisational procedures regarding medication.

For members of the public, appropriate over-the-counter pain relief may sometimes be considered for minor injuries according to the product instructions and the casualty’s individual circumstances.

However, medication should not distract from obtaining medical assessment for a suspected significant fracture.

For serious trauma, follow the advice of the ambulance service.

What Is a Dislocation?

A dislocation occurs when the bones forming a joint are forced out of their normal position.

It can cause:

severe pain
deformity
swelling
inability to move the joint normally

First aid is similar to a suspected fracture.

Support the injury in the position found and arrange medical assessment.

Do not attempt to put a dislocated joint back into position.

What Is a Sprain?

A sprain involves injury to ligaments around a joint rather than a broken bone.

Symptoms can still include:

pain
swelling
bruising
difficulty using the joint

It can be difficult to distinguish a serious sprain from a fracture without medical assessment.

If you are unsure, treat the injury cautiously.

Fracture First Aid Guide. Signs, Treatment and When to Call 999

Fracture First Aid in the Workplace

The type of fracture risk varies considerably between workplaces.

Higher-risk environments may include:

construction
manufacturing
warehouses
engineering
agriculture
outdoor work
transport

Employers should consider these hazards when carrying out their first aid needs assessment.

Appropriate first aid arrangements might include:

trained first aiders
suitable first aid equipment
reliable communication
emergency procedures
arrangements for summoning an ambulance
specialist equipment where the workplace risk assessment identifies a need

Our guide to the legal requirement for first aid at work explains workplace first aid responsibilities in more detail.

Do You Need a Splint in a Workplace First Aid Kit?

A splint is not automatically required simply because an organisation has a first aid kit.

First aid provision should be based on the organisation’s first aid needs assessment and the hazards employees face.

Some higher-risk or remote environments may decide that specialist immobilisation equipment is appropriate.

For a typical low-risk workplace, this may not be necessary.

You can read our guide to workplace first aid kit requirements when reviewing your equipment.

Fracture First Aid: What Not to Do

If you suspect a broken bone:

DO NOT deliberately move the injury to test it.

DO NOT straighten a deformed limb.

DO NOT push exposed bone back into a wound.

DO NOT attempt to relocate a dislocated joint.

DO NOT encourage someone to walk on a potentially fractured leg.

DO NOT apply a splint so tightly that it affects circulation.

DO NOT become distracted by an obvious fracture and miss more serious injuries.

Support the casualty, minimise unnecessary movement and arrange appropriate medical help.

Fracture First Aid: What to Remember

The most important principles of fracture first aid are straightforward.

CHECK

Make sure the scene is safe and look for more serious injuries.

KEEP STILL

Encourage the casualty not to move the injured area unnecessarily.

SUPPORT

Support the injury in the position found.

DO NOT STRAIGHTEN

Never try to force a broken or dislocated limb back into its normal position.

CONTROL BLEEDING

Manage serious bleeding and cover open wounds appropriately.

GET HELP

Call 999 for serious fractures and major trauma, or arrange appropriate medical assessment for less serious injuries.

MONITOR

Stay with the casualty and watch for deterioration.

Good fracture first aid is usually about protecting the injury from further harm, not trying to fix the broken bone yourself.

Learn How to Manage Injuries with Confidence

Fractures are one of the injuries first aiders may encounter following falls, workplace accidents, sporting incidents and other forms of trauma.

Practical first aid training gives learners the opportunity to practise casualty assessment, supporting injuries and deciding when emergency help is required.

First Aid and Safety Training provides:

We provide practical first aid training for individuals and organisations across the North East.

Explore our first aid training across the North East or contact First Aid and Safety Training to discuss your requirements.

You can also see our South Shields training centre and customer reviews on Google Maps.

Real Skills, Real Confidence.