tape,   clothing,   or   other   suitable   materials.   If possible,  one  person  should  hold  the  splints  in position  while  another  person  fastens  them. Although  splints  should  be  applied  snugly, they should NEVER be tight enough to interfere with  the  circulation  of  the  blood.  When  you  are applying splints to an arm or a leg, try to leave the  fingers  or  toes  exposed.  If  the  tips  of  the fingers or toes become blue or cold, you will know that  the  splints  or  bandages  are  too  tight.  You should  examine  a  splinted  part  approximately every half hour and loosen the fastenings if the circulation  appears  to  be  impaired.  Remember that any injured part is likely to swell, and splints or bandages that are applied correctly may later become  too  tight. INJURIES TO BONES A  break  in  a  bone  is  called  a  FRACTURE. There  are  two  main  kinds  of  fractures.  A CLOSED FRACTURE is one in which the injury is entirely internal; the bone is broken but there is  no  break  in  the  skin.  An  OPEN  FRACTURE is  one  in  which  there  is  an  open  wound  in  the tissues and the skin. Sometimes the open wound is  made  when  a  sharp  end  of  the  broken  bone Figure  4-52.—Closed  and open fractures. pushes out through the flesh; sometimes it is made by an object such as a bullet that penetrates from the outside. Figure  4-52  shows  closed  (A)  and  open  (B) fractures. Open fractures are more serious than closed fractures.  They  usually  involve  extensive  damage to the tissues and are quite likely to become in- fected.  Closed  fractures  are  sometimes  turned  into open  fractures  by  rough  or  careless  handling  of the victim. It is not always easy to recognize a fracture. All fractures, whether closed or open, are likely to  cause  severe  pain  and  shock;  but  the  other symptoms may vary considerably. A broken bone sometimes  causes  the  injured  part  to  be  deformed or   to   assume   an   unnatural   position.   Pain, discoloration,  and  swelling  may  be  localized  at  the fracture site, and there may be a wobbly move- ment if the bone is broken clear through. It may be difficult or impossible for the victim to move the injured part; if able to move it, there may be a grating sensation (crepitus) as the ends of the broken bone rub against each other. However, if a  bone  is  cracked  rather  than  broken  through,  the victim  may  be  able  to  move  the  injured  part without much difficulty. An open fracture is easy to  recognize  if  an  end  of  the  broken  bone  pro- trudes through the flesh. If the bone does not pro- trude,  however,  you  might  see  the  external  wound but  fail  to  recognize  the  broken  bone. If you are required to give first aid to a per- son  who  has  suffered  a  fracture,  you  should follow these general rules: 1. 2. 3. 4. 5. 6. 7. If there is any possibility that a fracture has been sustained, treat the injury as a frac- ture until an x-ray can be made. Get the victim to a definitive care facility at the first possible opportunity. All frac- tures require medical treatment. Do not move the victim until the injured part  has  been  immobilized  by  splinting unless the move is necessary to save life or to  prevent  further  injury. Treat  for  shock. Do  not  attempt  to  locate  a  fracture  by grating  the  ends  of  the  bone  together. Do not attempt to set a broken bone, unless a medical officer will not be available for many days. When a long bone in the arm or leg is frac- tured, the limb should be carefully straight- ened so that splints can be applied unless it  appears  that  further  damage  will  be 4-52