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Essential Medical Skills to Acquire: Splinting and Casting, by Cynthia J. Koelker, MD
In the introduction to this series I gave a brief outline of the medical skills that a layman should acquire when preparing for TEOTWAWKI. Injuries will be common among people required to be more active than they are accustomed to. Lacerations have already been addressed in Parts 1 and 2 of this series. Next we will turn to injuries that required immobilization for optimal healing including sprains, strains, and fractures.
To begin, what’s the difference between a strain and a sprain? To strain means to overstretch a muscle or tendon beyond its capacity to resist without tearing. A sprain means essentially the same thing but applies to ligament injury. A tendon is the fibrous termination of a muscle that attaches the muscle to a bone. The next time you eat a chicken leg, note that the rubbery part of the meat near the end of the bone is the tendon, which often maintains its bony attachment. In contrast, a ligament connects two bones but without a muscle, much like a strong semi-elastic band. Neither tendons nor ligaments have a good blood supply, which accounts for their slow healing. Knees are usually sprained, that is, the supporting ligaments are damaged. Ankles are commonly sprained as well, but since the leg muscles terminate near the ankle, it is sometimes difficult to tell a sprain from a strain. An Achilles tendon injury would be called a strain, but a twisted ankle is usually a sprain. In a sense, a sprain is a subset of strain-type injuries, and knowing the difference is not essential.
Next, what’s the difference between a break and a fracture? There is none, though many patients seem to believe that one or the other is worse. Medically speaking, they are equivalent terminology.
With any muscle or bone injury, the damage may be mild, moderate, or severe. Regarding strains and sprains, mild injuries generally resolve within minutes to hours, and involve only microscopic tears at most. They do not swell, cause bruising or persistent pain. The classic example is a twisted ankle, which limits walking for a brief time, but reverts to normal after a short rest. Patients rarely seek medical care for this degree of injury. These mild injuries are often termed first-degree. Third-degree injuries involve complete disruption of the muscle, tendon, or ligament, where the tissue is “torn in two.” The second-degree classification covers everything in between, from injuries that require days to heal to injuries that may cause permanent impairment. Without surgery as an option, third-degree injuries will rarely heal. Second-degree injuries are what patients typically seek medical help for and where you can become an excellent resource.
As for bones, a good mental image is that of Styrofoam, which can be crushed, slightly bent, or broken. A stress fracture is analogous to crushing; a greenstick fracture is similar to bending; a complete fracture is like breaking the foam in two; a comminuted fracture is like breaking the foam into multiple pieces.
Strains, sprains, and bones heal by gradually filling in the gap.
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