Paul George’s leg injury: Open Fractures and First Aid

The horrific nature of Indiana Pacers rookie Paul George’s leg injury has gripped everyone’s attention because of its rather graphic nature. I thought this would be a good time to go over what kind of injury happened and what to do if you need to apply first aid to someone in a similar injury.

The term that they use to describe this injury is a “compound tibial and fibular fracture”. The word ‘“compound” is added here to denote that the broken bones are openly visible, since the skin is broken. The word ‘“open” can also be used interchangeably with the word ‘“compound” in these cases. The nasty thing about open wounds of any kind is that there is a higher potential for infection. A fracture is a nasty place to get an infection because when a bone gets infected, (a condition called Osteomyelitis), it’s really tough to get rid of that infection (think months of antibiotics plus surgeries). So a compound /open fracture is more risky than your average fracture.

The tibia and the fibula are the bones of the lower leg that connect the knee to the ankle. If you look at the fibula, it’s a thin strip of bone which doesn’t really support much weight. But that’s not really its job. It serves as a great attachment point for most of the muscles, tendons and ligaments in your lower leg and feet. The tibia on the other hand is just the opposite. It’s a big, broad, weight bearing bone and doesn’t have much in the way of muscles attached to it.

First Aid for Open Fractures

1. Safety: In any First Aid situation, the first thing you need to do is make sure that YOU are in a safe situation to help. The next is to try and make sure the patient is in a safe situation where you will be able to apply the treatment in peace and wait for help to arrive.
2. Call for Help!: Call 911 or the equivalent in your area. ALWAYS call for help, never try and face a first aid situation ALONE if you can help it. It’s not good for the patient and it’s not good for you either.
3. Cut Away Fabric and Obstacles: This speaks for itself. You can’t render any first aid if there is a torn and bloody pair of jeans in your way. Try and remove excess clothing from the injury site as gingerly as possible using a pair of heavy duty scissors. Try and keep in mind the patient’s dignity and anxieties for privacy when you do this.
4. For Heavy Bleeding - Apply Firm Pressure: use a cloth or even your hand and apply pressure to the area BUT if there is little or no bleeding – DON’T APPLY PRESSURE. Bleeding is a tricky thing in this situation. You want to make sure the victim doesn’t lose too much blood, so your first instinct is to apply pressure to any compound fracture. The thing you have to realize is that the pressure may displace the fractured fragments even worse and cause more damage. Not to mention that the application of pressure in these situations is incredibly painful.
5. Do Not Clean: Do not try and wash the wound or clean it with any kind of antiseptic unless instructed to by a paramedic or doctor. Again, the first instinct when you see bone sticking out is to try and keep the wound clean. Pouring unsterile water or harmful antiseptics that are not meant for internal use into a gaping wound is very likely either going to cause an infection or damage the soft tissues (nerves, muscle arteries etc.) further.
6. Cover site with a sterile gauze, roll, crepe: The idea here is to get the patient ready for transport if at all possible. Try and cover the wound in a makeshift dressing to help keep it clean and also prevent onlookers and the patient themselves from aggravating the situation by the sight of the wound.
7. To the Hospital: Hopefully you did step 2 as early as you could and an ambulance will arrive by the time you are finished first aid. The paramedics will jump into action then, and at the hospital, you can turn your patient over to expert care confident that you have done the absolute best to help in this situation.