Fractures of the Arm and Hand

There are three long bones in each arm - one in the upper arm and two below the elbow. These are among the most commonly broken bones in the body. There is also a number of small bones in the wrist that are vulnerable to breaks. Fractures to the hand or fingers can be extremely painful because of the many nerve endings.

The principles of treatment are, as for all broken bones, to provide support to the injured part and to stop it from moving too much. Most people with a broken arm will be able to make their own way to hospital or a health centre, so treatment focuses on providing support that is appropriate when walking and stabilises the injured limb. This can be done with an improvised sling using clothing, or by using a triangular bandage to form an arm sling.

How to make an arm sling

1. Gently place the bandage under the casualty's arm, placing the point underneath the elbow.
2. Pass the top end of the bandage around the back of the casualty's neck, leaving a short end to be tied by the collarbone on the injured side.
3. Bring the bottom end of the bandage up carefully, ensuring that it fully supports the injured arm. Tie into place with a reef knot or bow.
4. For additional support, you can tie another triangular bandage. Fold into three (a broad fold) around the arm, avoiding the site of the fracture, to stop the arm from moving.

Broken elbow or an arm that cannot bend

If the broken bone is on or near the elbow it may not be possible for the casualty to bend the arm, either because of the pain or because the joint is fixed. In this case you need to treat the arm in the position found - do not try to bend the arm.

1. Help the casualty into the most comfortable position; this will often be lying down on the ground, but it may also be standing up with the arm hanging straight down.
2. Place padding around the injured part, both between the arm and the body and on the outside of the arm.
3. The casualty will need to be transported by ambulance. Do not attempt to bandage the arm if help is on its way as this will cause further discomfort and may make the injury worse.

Fractured wrist

In older adults, the wrist may be broken by a fall on to an outstretched hand, causing a break very low down on the radius (one of the long bones in the lower arm) known as a Colles's or dinner fork fracture. Other injuries can break one of the small bones to the wrist or cause a sprain that is particularly difficult to distinguish from a break.

First Aid Treatment

Provide support and immobilisation in the same way as for a break to the upper or lower arm. Remove watches and bracelets as these may contribute to cutting off circulation to the hand if the injury swells.

Hand fractures

Direct impact may break one or two of the small bones in the palm or fingers. Crushing injuries may break several bones and cause considerable bleeding. In addition the thumb, and even some of the fingers, may become dislocated.

First Aid Treatment

1. Gently cover any open wounds with a dressing or clean, non-fluffy piece of material. Encourage the casualty to raise her arm. This helps to reduce swelling and bleeding and also provides some pain relief.
2. If possible, remove rings and watches before the injury starts to swell. If jewellery has been crushed into the hand or swelling prevents its easy removal, pass this information on as soon as possible to the medical staff as early treatment will be needed to prevent damage to the circulation in the fingers.
3. Cover the injured area with a pad of soft fabric or cotton wool (taking particular Care if there are open wounds not to get strands of material stuck into the injury). This padding can be held in place with a cover created from a triangular bandage, which can also be adapted for crush injuries to the foot and for burns to the hand or foot.