What are fractures and sprains?
Fractures and sprains are the most common injuries in daily life and sports. Since their appearance and symptoms are similar, it is difficult to distinguish them, and if left untreated with self-diagnosis, healing may be delayed or sequelae may remain. If there is pain, swelling, or deformity, it is important to first seek evaluation at a medical institution.
At our clinic, within the scope of internal medicine and dermatology, we perform initial evaluation, first aid, and diagnosis using X-rays, and promptly refer to an orthopedic surgeon if surgery or fixation is required.
Immediate first aid after injury: "RICE"
Rest, Ice, Compression, and Elevation – these are the basics for the acute phase. By performing these four steps before seeing a doctor, you can suppress swelling, pain, and internal bleeding.
Differences between Fractures, Sprains, and Contusions
| Injury | Characteristics | Main Symptoms |
|---|---|---|
| Fracture | Discontinuity of the bone | Severe pain, deformity, inability to bear weight, abnormal range of motion |
| Dislocation | Displacement of joint surfaces | Joint deformity, restricted range of motion |
| Sprain | Injury to joint ligaments/capsule | Swelling, subcutaneous hemorrhage, pain during movement |
| Contusion | Subcutaneous/muscle injury (bone/joint intact) | Swelling, internal bleeding, pain at the site of impact |
| Muscle Strain | Partial tear of muscle fibers | Sudden sharp pain, swelling, pain during exercise |
Types and Symptoms of Fractures
Types of Fractures
- Simple fracture (closed fracture): Skin is not broken
- Compound fracture (open fracture): Bone pierces through the skin (risk of infection, emergency)
- Complete fracture: Bone is completely broken and separated
- Incomplete fracture (crack): Bone continuity is maintained but with a partial crack
- Comminuted fracture: Broken into three or more pieces
- Stress fracture: Microfracture due to repeated stress
- Avulsion fracture: Tendon/ligament attachment site peels off
Symptoms Suggesting a Fracture
- Heard a "gokki" or "bokki" sound at the time of injury
- Unable to move the affected area due to severe pain
- Obvious deformity (bent or shortened)
- Unable to bear weight
- Rapid spread of swelling and subcutaneous bleeding (dark bluish color)
- Bone protruding from the skin (open fracture, emergency)
- Abnormal range of motion (moves in a part that should not normally bend)
Severity of Sprains
Sprains are classified into three grades based on the degree of damage to ligaments and joint capsules.
| Grade | Extent of Damage | Symptoms/Treatment |
|---|---|---|
| Grade I (Mild) | Micro tear of ligament | Slight swelling/pain, improves in 2-3 weeks, elastic bandage |
| Grade II (Moderate) | Partial tear of ligament | Moderate swelling/difficulty walking, brace fixation for 3-6 weeks |
| Grade III (Severe) | Complete tear of ligament | Severe swelling/joint instability, cast fixation/consideration for surgery |
Common Sites of Sprains
- Ankle joint: Inversion sprains are most common
- Knee joint: Medial collateral ligament, anterior cruciate ligament
- Wrist joint: From falling on an outstretched hand
- Finger joint: Common in ball sports
- Cervical spine (whiplash): Impact from traffic accidents, etc.
Specific Methods for RICE Treatment
Rest
- Do not move the injured area
- Reduce burden with crutches/slings
- Rest from exercise/work
Ice
- Apply an ice pack or cold pack wrapped in a towel
- 15-20 minutes at a time, every 2-3 hours
- Focus on the first 48-72 hours after injury
- Do not apply directly to the skin to prevent frostbite
Compression
- Lightly compress with an elastic bandage (too tight can cause blood flow impairment)
- Check the color and sensation of fingers/toes while applying
Elevation
- Keep the affected area higher than the heart
- Reduces swelling and internal bleeding
- Elevate with a cushion even during sleep
Never apply heat immediately after injury
The first 48-72 hours after injury is a period of active inflammation. Heating causes vasodilation, which worsens swelling and pain. Avoid bathing, saunas, alcohol, and massage, and always apply cold.
What Not to Do After an Injury
- Move or bear weight while enduring pain
- Apply heat to the injured area (acute phase 48-72 hours)
- Massage the affected area
- Drink alcohol (worsens with increased blood flow)
- Force stretching "to heal it"
- Apply patches directly to the skin for long periods (to prevent rash)
- Overuse or prolonged use of painkillers
When to Seek Emergency Medical Attention
The following symptoms require an orthopedic or emergency medical consultation
These cases may be life-threatening or leave sequelae if left untreated.
- Bone protruding from the skin (open fracture)
- Obvious deformity/shortening
- Injured area is pale to purple and cold (blood flow impairment)
- Area beyond the injured site (fingertips, etc.) is immobile or numb
- Heavy bleeding
- Head injury with disorientation or vomiting
- Neck injury (more than whiplash)
- Abdominal or chest contusion with difficulty breathing or severe pain
- Falls in the elderly (possibility of femoral neck fracture)
Examination and Tests at Our Clinic
Flow of Examination
- Interview: Circumstances of injury, medical history, nature of pain
- Visual inspection: Check for deformity, swelling, subcutaneous bleeding, open wounds
- Palpation: Assess tenderness, joint range of motion, nerve/vascular function
- X-ray examination (within the scope of what can be handled by chest X-ray)
- First aid/prescription
- Referral to orthopedics if necessary
What We Can Do at Our Clinic
- Initial evaluation and first aid after injury
- Management of mild contusions and sprains
- Prescription of pain relievers and patches
- Simple bandaging and taping
- Infection prevention (wound cleaning for open wounds)
- Consideration for tetanus vaccination
Cases Requiring Orthopedic Referral
- Suspected fracture/confirmed by X-ray
- Requires cast fixation/surgery
- Reduction of dislocation
- Grade III sprain (complete ligament tear)
- Requires CT/MRI
- Rehabilitation
Treatment and Recovery Period Guidelines
| Injury | Treatment | Recovery Period |
|---|---|---|
| Mild contusion | RICE, pain relievers | 1-2 weeks |
| Grade I sprain | Elastic bandage, pain relievers | 2-3 weeks |
| Grade II sprain | Brace, rehabilitation | 4-8 weeks |
| Grade III sprain | Cast, consideration for surgery | 2-6 months |
| Simple fracture | Cast, rehabilitation | 6-12 weeks |
| Complex fracture/surgical cases | Surgery, long-term rehabilitation | 3-12 months or more |
About Pain Relievers and Anti-inflammatory Drugs
Oral Medication
- Acetaminophen: Easy to use for pregnant women and children
- NSAIDs (Loxoprofen, Celecoxib, etc.): Powerful anti-inflammatory effects, caution for stomach/intestines and kidneys
- Weak opioids (Tramadol): For pain not relieved by NSAIDs
Topical Medication
- Cooling patches (salicylic acid-based): Acute inflammation
- Warming patches: Improves blood circulation in chronic phase
- Topical NSAIDs (Loxonin gel, Voltaren gel, etc.): Local pain relief and anti-inflammatory action
Approach to Rehabilitation and Return to Activity
"Returning to full activity immediately after the immobilization period ends" is not advisable.
During immobilization, muscle strength and joint range of motion decrease. Gradual rehabilitation and a return-to-activity protocol that gradually increases load are key to preventing re-injury. Proceed patiently under expert guidance.
Example of Gradual Return to Activity (Ankle Sprain)
- Acute phase (1-7 days): Rest, cooling, limited weight-bearing
- Subacute phase (1-3 weeks): Begin weight-bearing while protected by a brace
- Recovery phase (3-6 weeks): Range of motion exercises, strength training
- Functional recovery phase (after 6 weeks): Balance training, sport-specific training
- Return to competition (8-12 weeks): Gradually, with permission from doctor/trainer
Fall and Fracture Prevention in the Elderly
In the elderly, femoral neck fractures, vertebral compression fractures, and wrist fractures are common, and are major causes of bedriddenness and decline in functional ability.
Points for Fall Prevention
- Maintain steps and slippery floors at home
- Utilize handrails and canes
- Choose appropriate footwear (non-slip)
- Review medication-induced dizziness
- Regular assessment of vision and hearing
- Lower limb muscle training and balance exercises
- Treatment for osteoporosis (Ca, Vitamin D, bisphosphonates, etc.)
Features of Our Clinic's Fracture and Sprain Treatment
- Handles first aid (guidance on RICE method) immediately after injury
- Capable of initial fracture evaluation with chest X-ray equipment
- Prescription of pain relievers, patches, and taping
- Wound cleaning for open wounds and tetanus vaccination
- Prompt referral to orthopedics if casts or surgery are required
- Evaluation and treatment of osteoporosis in the elderly
- Provides treatment considering overall health, with internal medicine available
- Walk-ins welcome / Open daily 9am-9pm / 1-minute walk from Jujo Station
Even if you think "it's nothing serious," get it checked.
It is not uncommon for what was thought to be a sprain or contusion to turn out to be a fracture. Especially, an accurate diagnosis immediately after the injury is the shortest path to recovery. If in doubt, please consult us first.
