Stormwind Medical Handbook: Bone Fractures

Stormwind
Medical Handbook
1. Medical Theory & Anatomy
2. Medical Duties
3. Soft Tissue Wounds
4. **Bone Fractures**
5. Head & Eye Injuries
6. Chest & Abdominal Injuries
7. Shock
8. Temperature Related Illness
9. Toxins & Poisons
10. Magical Wounds

The **Bone Fractures** chapter of the Stormwind Medical Handbook covers the terminology and treatment of common bone fractures. All medical staff should be able to identify and treat these wounds and determine triage based on the severity.

**Disclaimer:** The information edited here has been adjusted to suit the lore of World of Warcraft, and is not meant to be used as real-life saving techniques. Techniques utilized, and information contained in this document may not be best practice.

## Terminology

Common **Bone Fracture Terminology** will be defined and explained below.

### Complete Fracture

Associated with high-impact injuries, blunt force traumas, and accidents, a complete fracture is the separation of the bone between two or more parts. Classification of bone damage can vary from injury to injury. Upon breakage, the bone becomes jagged or fragmented, causing even further damage to the surrounding tissue. Protrusion of the bone is common among victims, increasing opportunistic infections. Identification of injury can be noted as malformation of the affected area. Internal pins may be required to ensure the bone has been successfully reset, followed by casting.

### Incomplete Fracture

Associated with injuries caused by twisting, turning, and inappropriate bending, incomplete fractures serve as an umbrella terminology of a partial, but not a complete breakage. The bone itself has broken apart, but is still connected at the ends. Immobilization and casting of the injury may be required, followed by supportive therapy post-injury.

### Comminuted Fracture

In a comminuted fracture, the bone has been crushed or pulverized to the point where the bone has fragmented. Depending on the severity, comminuted fractures can become complete fractures. Normally, injuries like this can cause splintering and cause further damage to the surrounding tissue due to the sharp edges. Severe pain accompanies comminuted fractures. If the fragments of bone cannot be easily located and removed, or if healing magic is not available, amputation may be the most merciful option.

### Non-Displaced Fracture

In a non-displaced fracture, the broken bone segments did not move, or displace, from their natural alignment after the break. While there may be damaged tissue at the location of the break, the bone in a non-displaced fracture does not exit the skin or surrounding muscle tissue. These are the easiest fractures to treat as the bone will not need to be reset into natural position.

### Displaced Fracture

In a displaced fracture, the broken bone segments moved, or displaced, out of their natural alignment after the break, dealing significantly more tissue damage than would be present in a non-displaced fracture. The jagged edges of bone may rupture muscle or even skin tissue at the location of the break. After initial treatment to stanch bleeding, cleanse and close any open wounds, the bone will need to be reset into natural position - which may cause further tissue damage and significant pain.

### Closed Fracture

A closed fracture is a break in the bone that does not protrude from the skin itself. Immobilization of the injury is required followed by therapeutic treatment post-injury.

### Open Fracture

An open fracture is a break in the bone that causes protrusion from skin. Opportunistic infections and external bleeding should be addressed immediately through the stanching, cleansing and closing of any open wounds.

### Clean Fracture

A clean fracture is a break in the bone that does not leave fragments or significant damage to the surrounding tissue. This is often the simplest form of bone fracture to treat.

### Contaminated Fracture

A contaminated fracture involves an infection in the tissue or even the bone at the point of fracture. Such a fracture is dangerous as the injury presents a risk to necrotize the surrounding flesh. If cleansing magic cannot be applied to treat the infection, amputation may be the most merciful option.

## Treatment

Common **Treatment Methods** for bone fractures shall be defined and explained below.

### Resetting

To reset a fracture is to physically move, rotate, or twist bone that has been displaced in a fracture back to its natural position. Once the bones have been maneuvered into their correct setting, a splint or brace should be applied.Typically done by forcefully moving the limb in question, this process can be agonizing for the patient. Anything that might ease or offset the pain should be offered to the patient, whether it be a cloth to bite down upon, potions of healing, or numbing agents distilled from animal toxins.

After resetting is performed, the limb in question should be immobilized with a splint or sling if applicable. The limb should be examined weekly for abnormalities at the site of the break. If the bone shifts into the incorrect position without being caught, the bone may need to be re-broken and reset into proper position again.

### Sling

A sling is used to support an immobilized arm. Consisting of a cloth or leather pouch and a strap that wraps around the neck, the immobilized arm should be gently cradled in the pouch while the strap supports the weight of the limb. The strap should be adjustable in order to position the sling flush against the patient’s chest. The sling should be secured at an incline with the hand higher than the elbow in order to reduce swelling and further pain.

### Splinting

Splinting is the act of immobilizing a limb so that a bone fracture may set, or at the very least, cause no further damage to the surrounding tissue. If the fracture is an open one, sanitize the wound and stanch bleeding before anything else. If the splinted If the bone is displaced unnaturally at the fracture, it should first be realigned to promote proper healing. Wrap the injury in clean bandaging before positioning two wooden “splints” parallel to the bone’s natural orientation. Wrap the limb and splints together so that they cannot move. Do not wrap the limb too tightly, for doing so would restrict blood flow. After securing the splints, check the extremities of the limb for discoloration from pooled or restricted blood flow. If so, loosen the bandages. If the splinted limb is an arm, the arm should be supported in a sling. If the splinted limb is a leg, crutches should be provided so that the patient may use them for walking support instead of the wounded leg.

### Exploratory Surgery

Sometimes a patient’s fractures are not easily diagnosable and must be investigated with exploratory surgery. Such surgery should be as directed and informed as possible in order to reduce the number of incisions and probes into the patient’s tissue. If the patient is awake and conscious, they should be able to identify where they experienced blunt impacts that would cause fractures. If the patient is not able to identify such, then the one performing the surgery should look for sites of swelling or discoloration of the flesh. As with any laceration of incision wound, any exploratory surgery incisions should be cleaned, closed, and dressed in order to avoid infection.

### Amputation

As mentioned, amputation is the removal of flesh, bone, or entire appendages that can not be treated effectively enough to justify leaving them to fester. During amputations, the attending surgeon must be aware of any major blood vessels that traverse along the section. While it is always in the best interest of the patient to preserve as much tissue as possible, it is also important to prevent as much pain as possible. While sawing through bone may converse flesh, it will cause a lengthy recovery time and increase the susceptibility of opportunistic infections. In cases of bone fracture where the break can not be feasibly saved, it is most merciful to amputate along the fracture. Remove any splinters of bone lodged in the flesh and ensure that the open wound is sanitized before cutting the flesh at the edge of the bone. Sand down any remaining jagged edges of bone before suturing the remaining flesh around the stub.

### Prosthetic Replacement

If a limb must be amputated, a prosthetic replacement may be procured that can restore limited functionality to the patient. Often carved from wood and articulated with steel, the prosthetic can be as simple as a claw or complicated with manipulative joints. Most are attached in place of the missing limb with sturdy leather straps. These tools help victims return to some level of normalcy.