1. TLK
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    TLK Active Member

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    Breaking a Limb

    Discussion in 'Research' started by TLK, Aug 18, 2013.

    Hi guys,

    I'm fortunate enough to have never broken a limb, and neither has any of my close family or friends (to my knowledge) so I figured here was as good a place as any to ask some questions.

    Firstly, slightly off the topic, I wanted to ask you guys if you thought this is plausible: basically, two of my characters fall down a large chasm. They would have died if not for a deep pool of water at the bottom. Needless to say, the impact would hurt, but could you break a limb falling into water? There is debris falling down with them (bridge collapses) so could any of this, say, collide with one of them and break something.

    Secondly, what happens when you break a limb? One character breaks an arm, the other a leg or so I plan, so anything relating to those two limbs would be great. I imagine there is great pain, but can you move your broken limb? Can you feel it? Would you know immediately that something is broken and would you know what limb it was? Bearing in mind, of course, that you've just fallen down a massive chasm into a pool of freezing water and there's probably other things going on in your mind.

    If anyone could relate their experiences of their breaking a limb (or someone they know), that'd be a massive help. And if anyone happens to have broken their limb by falling down a massive chasm into a pool of freezing water and could relate their experiences of that, that would be simply fantastic.

    Thanks in advance! :)
     
  2. badgerjelly
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    badgerjelly Member

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    I have never broken a limb either. I do know that you can break a limb, and even die, from impact on water.

    I have heard from friends, and elsewhere, that the pain is very sharp at first but once the endorphins kick in there is little or no pain at all. My friend said it was a very strange experience because he could see his bone sticking out of his skin but didn't really feel much pain at all.

    Once thing you have to remember though is that everybody has different pain thresholds. It is also possible to blot out pain completely (some people have surgery when they are fully conscious and feel absolutely no pain).
     
  3. jazzabel
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    jazzabel Contributing Member Contributor

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    In this situation, they can break a limb on impact, although it's more likely to be from hitting a rock underwater, or the ground, or from something falling on them. Also, soft tissues can split in contact with water surface, so they can have flesh wounds on the stomach, back, etc.

    One of the biggest dangers is obviously breaking the neck, and a person can move around with that for hours and even days, before collapsing due to a bone fragment obstructing nerve or blood supply. Vertebrae could well break on impact with water, without much pain or weird sensation, because they are such tiny bones. Limb injuries are different.

    People usually know if they've broken a limb. There will usually be a sensation of a bone snapping, and the resulting feeling of faint, nausea, generally feeling unwell, due to the release of bone marrow, fat cells and the rest into the blood stream. These can (very rarely) cause an embolism.

    However, in high adrenaline situations (such as the one you are describing) all this might not be immediately apparent, due to the effects of adrenaline which, amongst other things, causes, peripheral vasoconstriction and lack of sensitivity to pain. Pain of injuries, in general, becomes most pronounced when the adrenaline of injury wears off and tissues cool down, 3-6 hours post injury.

    The biggest problem with leg breaking is that weight bearing might become very difficult despite the adrenaline, and impossible once adrenaline wears off. In water it's not such a problem, but once they came out, moving around will be a huge task.

    Emergency treatment for broken limbs is immobilisation. It can be done easily with a piece of wood and strips of fabric (any First Aid manual will have info on this). It might help the injured walk, although they'll still be very slow.

    The risks of hypothermia also can't be underestimated, so they need to get dry and warm up within minutes, also have to eat something, because they need energy to start repairing the tissues. Otherwise, they have a very high chance of dying.
     
  4. mrieder79
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    mrieder79 Not a ground squirrel

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    Hi. Agree with much of what Jazzabel said. I would like to qualify the statement regarding vertebral fractures. If you fracture one of the small bones that prodrudes from the posterior aspect of the spine, then it may go undetected. If, however you break the connection between the vertebral body and the posterior vertebral arch (this is called the pars interatricularis) then it is a serious medical condition that is generally very painful and leads to numbness, tingling, and weakness in the lower extremities. Also, if you fracture a vertebral body (the big part of the vertebra) then it is usually very painful and debilitating. It is possible that the weightlessness of water and the temperature of the water combined with the adrenaline surge of the fall could distract someone from it, but once they were on land and trying to move against gravity, it is likely they would notice it.

    Fracturing your Femur (upper leg bone) or Tibia (bigger lower leg bone) would likely be enough to send someone into shock if it was a complete fracture, especially if it is compound (the bone is protruding through the skin).

    How high is the fall? Falls in excess of 50-70 Ft are quite hazardous.

    A fractured arm is not usually as serious (unless an artery is severed) as you still retain your ability to walk. A fractured leg would severely limit mobility, especially if no sort of assistive device for walking could be constructed.

    If you characters are not going to be receiving medical attention for a long time and one of them has a serious fracture of the leg, then the possibility of mortality would likely be high, especially if it is a compound fracture due to the likelihood of infection.

    It is very possible for people to not feel severe breaks, even of the femur (the upper leg bone). I had a friend who fractured his femur in a motorcycle accident and didn't notice it at first. I have heard of people tearing ligaments in their knees and being able to ski downhill holding their knee together with their hands. I have also seen people disabled by the same injury.

    I think you have some leeway with how your characters perceive the injuries. Just make sure you realize how serious a fracture can be if it is complete. An incomplete fracture would naturally be less severe.
     
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  5. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Here's a little more medical, some of which has been mentioned:

    Hitting water after falling from a distance is like hitting concrete, you can definitely break bones. It's the surface tension that is the problem. Losing consciousness would also be a big issue as you could then drown.

    Things falling after you would have their momentum broken at the surface so they could injure you if you were at the surface but in only short distance it would be a bump not a whack. Even a bullet's velocity stops in just a few feet of water. But there are other things to consider if it's a river. Then the debris would move with the water and regain 'whack-you' momentum.

    Fractures depend on how the bones break, if the break is at a joint, if the skin is broken, and how strong the muscles are that are still attached.

    You can walk on a cracked bone but you can't put weight on anything that disrupts the skeletal support. So if the fracture was completely through the bone in a leg, you could not put any weight on that.

    The large bones, humerus and femur, have very big muscles attached. A complete fracture causes the broken ends to slide past each other. That's why these fractures require traction to set the bone and hold it in place until sufficient healing takes place.

    Broken skin with a fracture presents considerable infection risk.

    Bones are lined with a very vascular membrane called the periosteum. You can often tell the difference between a sprain and a fracture based on the extent of the bruising (can take a day or so to be visible).

    Kids' bones heal faster than adults because they are growing anyway, the growth hormone speeds up bone growth. Adults are not so lucky.

    And from my personal experience, both times I broke my toe, the bruise extended all the way to my heel by the second day. And don't let anyone tell you a broken toe doesn't hurt that much. It's a myth. ;)
     
  6. TLK
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    TLK Active Member

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    Awesome, thanks for the replies, guys. Really detailed and informative, thanks! I'll definitely be making use of this information :)

    The characters do survive and that's largely because the hypothermia and broken limb issues are soon addressed.
     
  7. T.Trian
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    T.Trian Overly Pompous Bastard Staff Supporter Contributor

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    I have no medical knowledge, but I've broken a few bones over the years. Every one of them has been pretty painful from the start, but although two of them happened during thai boxing, I could finish the round (sparring, not an actual bout) with the injury although I avoided striking with the damaged limb (except when I broke a thumb, I could still use the elbow of the same hand to strike).
    When I broke a big toe as a kid, it did hurt, but I stayed the rest of the school day and limped home on my own. It was then that I noticed the toe / instep were all black / blue, so that's when I went to see a doctor and found out I'd broken a bone.

    Anyway, none of my injuries have been compounds, so I don't know about those, but every time I broke a bone, it hurt about as much as any harder knock would. The pain is similar to what you feel when you e.g. jab your toe into something hard. The difference is that when the bone breaks, the pain doesn't go away like it eventually does when there's no real damage sustained. After the adrenaline dump goes away, you're left with a kinda dull, throbbing ache, but moving the broken limb / digit or hitting it / applying pressure on it hurts quite a bit (imo more than actually breaking it).

    Now that I think about it, a hematoma in my arm (got it after the cast was removed from when my tricep got sliced almost in half) was more painful than a cracked limb as was the procedure where a doctor emptied the hematoma with a big-ass needle without any anesthesia. But to reiterate, mine have been pretty mild breakages, and I'd imagine a decent compound fracture would hurt quite a bit more esp. once the adrenaline starts to fade.
     
  8. matwoolf
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    matwoolf Contributing Member Contributor

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    You should google a few accounts of dislocated shoulders, poking tibias, broken fibias.

    Generate emotions of pain in your mind; think white agonizing bone snap, a stranger's voice shrieking out of your own skull, hyperventilion, drowning on bubbles of blood. People pass out. You have to slap, or punch - I'll check, to bring them round.

    So far you've had one finger, one toe. I've broken my hand, thumb, all my fingers on one hand. Thumb was the worst, toes don't even count. No point even going to a doctors with a broken toe because there's nothing they can do. Stitches hurt too, without anaesthetic.

    All pales compared to childbirth - but they always say that.
     
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