MFA-L2.3

Fractures, dislocations and immobilisation

MFA-M2 · Trauma · MFA-M2-A Bleeding and shock, burns and heat, fractures, and head and spinal injuries.

The first aid job with a fracture is to stop it getting worse: **support it in the position found**, check the circulation beyond it, and treat for shock.

Trauma: bones and joints

Governing: Table A-VI/4-1 'fractures, dislocations and muscular injuries'; MNTB MFA content modules 9-10.

Recognition

Sign Suggests
Deformity, shortening, rotation Fracture or dislocation
Swelling and bruising Fracture, sprain or both
Pain on movement, loss of function Any of the above
Grating (crepitus) Fracture; do not test for it
Bone visible or a wound over the site Open fracture

If you are not sure, treat as a fracture. The mechanism tells you a lot: a fall from height, a limb trapped by a tender being recovered, a foot crushed under a shifting fender.

Principles

  1. Support in the position found. Steady the joints above and below with your hands until splinted.
  2. Check circulation, sensation and movement (CSM) beyond the injury: colour and warmth of fingers or toes, capillary refill, feeling, wriggling. Record it before and after splinting.
  3. Immobilise. Upper limb to the body with a sling; lower limb to the good leg with padding between, or with a splint. Pad hollows. Tie off on the uninjured side.
  4. Treat for shock and keep warm.
  5. Nothing by mouth if an operation may follow.
  6. Get advice from TMAS; most fractures at sea mean a diversion or landing.

Open fractures

Cover the wound with a sterile dressing. Control bleeding by pressure around the protruding bone, never on it. Build up padding either side and bandage over. Do not push bone back in. Infection risk is high; the Medical Care officer will discuss antibiotics with TMAS.

Particular fractures

Site Watch for
Skull, face, jaw Airway compromise, head injury (lesson 2.4)
Ribs Painful breathing; several broken ribs or a flail segment affect ventilation
Pelvis Major internal bleeding; do not rock or spring the pelvis
Femur Blood loss into the thigh; shock
Spine See lesson 2.4

Dislocations and soft tissue

Do not try to put a dislocation back. Support in the most comfortable position and ask TMAS; reduction is a Medical Care decision under telemedical guidance.

Sprains and strains: rest, cold pack wrapped in cloth, compression bandage, elevation. Recheck circulation after compression bandaging.

Moving the casualty

On a yacht the hard part is often the extraction: a crew mess down a steep companionway, or an engine room ladder. Immobilise before you move. Use the stretcher you drill with, and plan the route before you lift. Casualty handling is part of the MNTB MFA course for this reason.

CAUTION — Tender and toy injuries Jet-ski and towable accidents produce high-energy lower-limb and pelvic injuries. Treat any such casualty who is pale and fast-pulsed as bleeding internally until proven otherwise.

TIP — Improvise Rolled lifejackets, fender covers, foam cushions and boat hooks all make usable padding and splints. A triangular bandage and a magazine will immobilise a wrist.

Practice questions

5 questions

recall · core

What is the first aid principle for a suspected fracture? (a) Apply heat (b) Support and immobilise it in the position found (c) Straighten it to reduce pain (d) Keep the casualty walking to prevent stiffness

recall · core

Why are femur and pelvic fractures particularly dangerous? (a) They can cause major internal blood loss and shock (b) They always need surgery at sea (c) They are usually painless (d) They cannot be splinted

recall · core

What should you check beyond a limb injury before and after splinting? (a) Temperature at the wound (b) Circulation, sensation and movement (c) Nothing if the splint is well padded (d) Blood pressure

recall · core

How should you manage a dislocated shoulder as a first aider? (a) Reduce it immediately (b) Strap it tightly to the chest in the anatomical position (c) Leave it unsupported (d) Support the arm in the most comfortable position and seek medical advice

scenario · core

A deckhand falls from a passerelle onto the dock and has an obviously deformed lower leg with bone showing through the skin. He is conscious and in pain. What do you do? (a) Cover the wound with a sterile dressing, control bleeding around the bone, immobilise in the position found and check the foot's circulation (b) Push the bone back under the skin and splint (c) Apply a tight compression bandage directly over the bone end (d) Walk him back aboard to the crew mess

Independent study. xplor is not an accredited training provider and awards no certificate or Certificate of Competency. The Medical First Aid certificate of proficiency is issued only on completion of an MCA-approved course with practical assessment on manikins and simulated casualties, and nothing here replaces hands-on training. AI-drafted content pending subject-matter-expert review.