Da wulilen (composé) kari, kolo ladonni min bɛ kɛnɛ kan, ani kolotugudaw¶

kari dafalen (tariku la, a bɛ fɔ a ma ko kari faralen ɲɔgɔn kan) bɛ kɛ tuma o tuma ni kolo karilen bɛ kumaɲɔgɔnya kɛ ni kɛnɛma lamini ye fari ni duguma yɔrɔ nɔgɔlenw karilen fɛ. Hali ni kolo karilen caman bɛ na kosɛbɛ ni kolotuguda tama finman walima joli nɔgɔlen ye min bɛ ye ka bɔ fari la, kari dafalen fana bɛ kɛ tuma o tuma ni kolotuguda dɔ bɔra a gosi waati la, ka segin ka segin fari jukɔrɔ o yɔrɔnin bɛɛ, ka sɔgɔsɔgɔninjɛ dingɛ fitinin dɔ to yen min bɛ dibi, min bɛ bɔ kari yɔrɔ yɛrɛ la.

Kari dafalen bɛɛ ye kolotugudaw opereli kɔrɔtɔlen ye min bɛ waati kɔnɔ kun saba kosɔn: joli bɔli jugumanba kɛnɛma ni kɔnɔna na, banakisɛw ka nɔgɔli tilennen kolotugudaw la min bɛ na ni kolotuguda jugumanba ye (kololabanaw) ani kolotuguda tɛ ɲɔgɔn na, ani joliba ni nɛrɛmugu kɛrɛfɛtaw minɛni walima u kinni min bɛ farikolo yɔrɔw baga bila mɔgɔ la. Ni aw bɛ joli kunbɛncogo dɔn k’a sɔrɔ aw ma digi kolotuguda nɔgɔlen dɔ kan min bɛ bɔ kɛnɛ kan, mun na aw man kan k’a ɲini abada ka kolotuguda min bɛ kɛnɛ kan, o gɛrɛntɛ ka segin fari jukɔrɔ, aw bɛ kolo min bɛ kɛnɛ kan, aw bɛ se ka o tanga cogo min na walasa a kana ja ni kɔgɔmugu sterili ye, ani cogo min na aw bɛ se ka yɔrɔjan Pulse, Motor, and Sensation (PMS) sɛgɛsɛgɛli kɛ sani aw ka sɔgɔsɔgɔninjɛ kɛ ani a kɔfɛ, o bɛ senkɔni ni a sirilen fila bɛɛ mara banabagatɔ ka ɲɛnamaya.

Aw bɛ o kɛ sisan¶

1. Aw ye aw ka sigida kɔrɔtɔko nimɔrɔ wele joona ani ka Advanced Life Support (ALS) dɛmɛbagaw ɲini. Aw bɛ 911 wele Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri, 000 Ɔsitarali, walima aw bɛ a ka kunnafonisɛbɛn lajɛ kɔrɔtɔko nimɔrɔw.
2. Aw bɛ kɛnɛma joli min bɛ mɔgɔ ka ɲɛnamaya bila farati la, aw bɛ o kɔlɔsi fɔlɔ k’a sɔrɔ aw ma a gɛlɛya ka jigin kolo bɔlen kan. Ni joli bilenman jɛman bɛ bɔ walima ka bɔn ka bɔ senkɔni na, aw bɛ jagokɛla ka fiɲɛbɔlan turniquet kɛ santimɛtɛrɛ 5 fo 7 (santimɛtɛrɛ 2 fo 3) sanfɛ (kɛrɛfɛ) kari joginda da wulilen sanfɛ (aw kana a ɲɛsin kariyɔrɔ ma walima kolotuguda dɔ kan abada). Walasa ka jolisira walima kolotugudaw bɔli sabati, aw bɛ gaze steriliw digi ka ɲɛ joginda dakunw na ka kolo da lamini walima ka doughnut/twin-roll ring pad belebeleba dɔ jɔ kolo bɔlen lamini na walasa aw kana kolo kuncɛ nɛrɛmuguma sɔgɔ abada ka kɛ nɛrɛmuguma ni joli siraw ye.
3. AW KAN’a ɲini abada ka kolotuguda dɔ gɛrɛntɛ ka segin joginda kɔnɔ ani aw kana banakisɛfagalanw ko walima ka a bɔn kolo la abada. Ni aw ye kolotuguda nɔgɔlen dɔ gɛrɛ ka segin fari jukɔrɔ, o bɛ bɔgɔ, finimuguw ani fari banakisɛw sama ka don kolotuguda la min tɛ bana ye, wa a bɛ se ka kɛ sababu ye ka joli sira walima nɛrɛmugu kɛrɛfɛla tigɛ tilayɔrɔ fila la.
4. Cover the exposed bone and open wound with a large sterile dressing moistened with sterile normal saline (0.9% sodium chloride) or a clean dry sterile trauma pad. Keeping exposed bone cortex and periosteum covered with a sterile saline-dampened pad (topped with a dry outer bandage) prevents the living outer bone cells from drying out and dying while blocking airborne bacteria.
5. Check distal circulation, sensation, and movement (the PMS check) below the fracture BEFORE and AFTER splinting. Gently feel for the distal pulse (radial pulse at the wrist or dorsalis pedis/posterior tibial pulse at the foot), check capillary refill and skin warmth/color in the fingers or toes, and ask if the person can feel light touch and wiggle their fingers or toes.
6. Immobilize the limb in the exact position found by splinting the joint above and the joint below the fracture, and keep the patient strictly NPO (nothing by mouth) and warm. Only if the lower limb is grossly angled AND the foot or hand below the break is cold, pale/bluish, and completely pulseless, and paramedics are more than 15 to 30 minutes away, should a trained responder apply gentle longitudinal traction to align the limb enough to restore blood flow.

Emergency decision tree for open (compound) fractures¶

flowchart TD
    Start["Suspected Limb Fracture with Bleeding Skin Wound or Visible Protruding Bone"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Put on nitrile gloves and cut clothing away to expose entire limb"]
    BleedCheck{"Is There Life-Threatening Arterial Spurting<br/>or Uncontrolled Pouring Blood?"}
    TourniquetStep["APPLY WINDLASS TOURNIQUET IMMEDIATELY<br/>1. Place tourniquet 5 to 7 cm (2 to 3 in) ABOVE the open fracture wound<br/>   (Never directly over the broken bone or over the knee/elbow joint)<br/>2. Tighten windlass until bright red bleeding stops completely<br/>3. Write exact time of application on tourniquet strap"]
    RingPadStep["CONTROL NON-ARTERIAL BLEEDING SAFELY<br/>1. DO NOT press directly down on top of protruding bone<br/>2. Press sterile gauze firmly around the soft-tissue edges beside the bone<br/>3. Build a bulky twin-roll or doughnut ring pad around protruding bone"]
    WoundCover["DRESS THE EXPOSED BONE & OPEN WOUND<br/>1. DO NOT push bone back inside; DO NOT scrub wound<br/>2. If gross loose gravel sits on skin beside wound, gently rinse with sterile saline only<br/>3. Cover exposed bone with sterile saline-moistened gauze + dry outer pad<br/>4. Wrap bandage snugly around ring pad without pushing bone inward"]
    PMSCheck1{"Perform First Distal Neurovascular (PMS) Check:<br/>Is the Hand/Foot Below the Break PULSELESS, Cold, and Pale/Blue?"}
    PulselessCheck{"Is the Limb Severely Angled/Twisted AND<br/>Is EMS Transport > 15 to 30 Minutes Away?"}
    GentleAlign["ISCHEMIC LIMB SALVAGE REALIGNMENT<br/>1. Support above and below fracture with both hands<br/>2. Apply smooth, gentle inline traction to untwist kinked artery<br/>3. STOP immediately if bone catches, severe resistance is felt, or bone starts retracting<br/>4. Re-check pulse immediately"]
    SplintAsFound["SPLINT IN EXACT POSITION FOUND<br/>1. Pad all gaps generously with soft towels or clothing<br/>2. Immobilize the joint ABOVE and the joint BELOW the open fracture<br/>3. Leave fingers or toes exposed to monitor color and warmth"]
    PMSCheck2["Perform Post-Splint PMS Check Every 10 to 15 Minutes<br/>Keep patient strictly NPO (nothing by mouth) and wrap in warm blankets"]

    Start --> CallEMS
    CallEMS --> BleedCheck
    BleedCheck -->|Yes: Arterial / Massive Bleed| TourniquetStep
    BleedCheck -->|No: Venous / Marrow Oozing| RingPadStep
    TourniquetStep --> WoundCover
    RingPadStep --> WoundCover
    WoundCover --> PMSCheck1
    PMSCheck1 -->|No: Pulse Present, Warm Pink Digits| SplintAsFound
    PMSCheck1 -->|Yes: Pulseless, Pale, Cold Hand/Foot| PulselessCheck
    PulselessCheck -->|Yes: Gross Angulation + Delayed EMS| GentleAlign
    PulselessCheck -->|No: EMS Near or Bone Locked| SplintAsFound
    GentleAlign --> SplintAsFound
    SplintAsFound --> PMSCheck2

Gustilo-Anderson ka kari dafalenw danfara: Mun na hali joginda misɛnni min bɛ kari lafiɲɛbɔ waati la, o ye kɔrɔtɔko ye¶

Many people assume an open fracture only happens when 5 centimeters (2 inches) of white bone sticks out of a leg. In reality, orthopedic surgeons classify open fractures using the Gustilo-Anderson grading system into three major tiers, and Type I is the one most frequently missed by laypeople:

Anatomy and pathophysiology of an open bone injury¶

1. Why broken bones bleed so heavily (even without cutting a named artery)¶

Laypeople often forget that living human bone is not dry white chalk; it is a highly vascular organ supplied by high-flow nutrient arteries that enter the bone shaft and branch through a rich network of sinusoids inside the red and yellow bone marrow (medullary canal). * When a large long bone snaps open, blood pours out of both torn ends of the medullary canal as well as the shredded periosteum and surrounding muscle beds. * Even in a closed fracture, internal blood loss into the surrounding compartment is massive, and in an open fracture, blood loss often doubles because external skin tamponade is lost:

2. Mun na Periosteum ni Cortical Bone ka kan ka to ji la¶

Kolo ɲɛnama bɛɛ sirilen don joli sira gɛlɛn dɔ la min bɛ wele ko periosteum, o min bɛ kolotugudaw ni joli sira mikoroskɔpikiw ta minnu bɛ karilenw kɛnɛya. * Ni kolo laban dɔ bɔra fari la ka kɛ fiɲɛ jalen ye, fiɲɛ walima tile, kolotuguda kolotuguda nɔgɔlen ni Haversian kɔkanna kanal minnu bɛ kɔkolo kolo la olu bɛ ja (u bɛ ja) miniti 20 fo miniti 30 kɔnɔ. * Ni kɔkolo kolo jara dɔrɔn, kolotugudaw minnu bɛ o kɛnɛma yɔrɔ la, olu bɛ sa (kɔrikolo koloci), o bɛ kolo ɲɛnama kɛ nɛgɛso salen ye (a sequestrum) banakisɛw bɛ min kolo nɔgɔya la ani farikolo tɛ se ka kɛnɛya ni opereli ma kɛ ni kolo tigɛli ni a tigɛli tɛ. * Ni aw ye kolo min bɛ kɛnɛ kan, aw bɛ o datugu joona ni gaze sterili ye min mɔlen don ni saline normal 0,9% sterili ye (walima ji sanuman min bɛ se ka min ni saline sterile tɛ sɔrɔ) o bɛ kolotugudaw ka ɲɛnamaya lakana fo banabagatɔ ka se opereli yɔrɔ la.

3. "Fɛntɛri sanulama min bɛ kɛ sanga 1 ka se sanga 3 ma" banakisɛfagalanw tali jolisira fɛ¶

Kɛnɛyaso ka kolotugudaw ka sɛgɛsɛgɛliw y’a jira ko furakɛlifɛn kelen min nafa ka bon kosɛbɛ kololabanaw (kolo jugumanba) kunbɛnni na kari dafalen kɔfɛ, o ye banakisɛfagalan minnu bɛ kɛ joli la, olu bɛ se teliya cogo min na ka se kari joli la. * Ni sefazɔlini IV (ka fara gram-negatif coverage kan Grade III walima penicilline/metronidazole kan foro/bɔgɔ kɔnɔ clostridial nɔgɔli) daminɛna miniti 60 kɔnɔ (ani a tɛ tɛmɛ lɛri 3 kan) jogin kɔfɛ, kolo jugumanba sɔrɔli hakɛ bɛ dɔgɔya ka tɛmɛ kɛmɛsarada la 60 kan. * O de kama hali ni a bɛ i ko Grade I da wulilen karilen fitinin (joli dingɛ fitinin min bɛ milimɛtɛrɛ 5 bɔ senkɔni walima bolokɔni karilen kan) ka kan ka taa joona dɔgɔtɔrɔso la kɔrɔtɔko yɔrɔ la anpulu fɛ sanni ka kɔnɔni kɛ fo sɔgɔma.

Fɛɛrɛ min bɛ kɛ senfɛ-senfɛ: Ka kari dafalen dɔ ɲɛnabɔ foro kɔnɔ¶

Taabolo fɔlɔ : Aw bɛ farikolo yɔrɔ bɛɛ bɔ kɛnɛ kan ka ɲɛ¶

1. Aw bɛ furakɛli nitirili ganw don.
2. Aw bɛ finiw tigɛ ka bɔ ni joginda tigɛlanw ye walima ni sizo ye: Aw kana a ɲini abada ka pantalon sen walima jakite bolokɔni sirilen sama ka bɔ senkɔni karilen kan. Fini samali bɛ fini nɔgɔlen sama ka tɛmɛ kolo jiralen kan ani ka karilen kunw siri joli sira ni nɛrɛmugu kɛrɛfɛ. Aw bɛ pantalon sen walima a bolokɔni tigɛ ka ɲɛ walasa ka farikolo yɔrɔ bɛɛ bɔ kɛnɛ kan k’a ta kɔkili/kamankun na ka jigin fo senkɔniw/bolokɔniw.
3. Remove rings, watches, bracelets, and shoes immediately (if safe): Swelling travels rapidly down an injured arm or leg. A wedding ring or wristwatch left on a fractured arm becomes an unyielding metal tourniquet within 30 minutes, causing finger necrosis. Slip rings and watches off immediately before the fingers swell.

Step 2: Control bleeding around protruding bone (The Ring-Pad & Tourniquet Protocol)¶

1. If there is life-threatening arterial bleeding (bright red blood spurting with each heartbeat or rapidly pooling on the ground):
2. Do not waste time trying to press delicately around a bone shard while a femoral, popliteal, or brachial artery bleeds out.
3. Immediately apply a commercial windlass tourniquet (such as a CAT or SOFTT-W) 5 to 7 centimeters (2 to 3 inches) proximal (above/closer to the heart) to the open fracture wound.
4. Key Tourniquet Placement Rule for Fractures: Never strap a tourniquet directly on top of the protruding bone or directly over the fracture site (where tightening the strap would grind the broken bone ends into the artery), and never place it directly over the knee or elbow joint. If the open fracture is in the lower leg (tibia) and very close to the knee, place the tourniquet right above the knee on the lower thigh. Tighten the windlass until bright red bleeding stops completely, lock the clip, and write the time on the strap.
5. If there is steady venous or bone-marrow bleeding without arterial spurting:
6. Never press flat down on top of a protruding bone tip.
7. Instead, place sterile gauze pads around the edges of the skin wound right at the base of the bone and press firmly against the soft tissue beside the bone.
8. Build a Twin-Roll or Doughnut Ring Pad (exactly like stabilizing an impaled object): take two thick rolls of roller gauze (or fold a triangular bandage or clean towel into a thick ring) and place them on either side of the protruding bone so they rise higher than the tip of the bone. This ring pad protects the bone tip from getting bumped or pushed inward when you wrap the outer dressing.

Step 3: Wound contamination rules and the Moist-Plus-Dry Dressing¶

1. What if dirt, grass, or gravel is stuck to the protruding bone?
2. Do not scrub, pick at, or brush the bone with gauze or fingers. Mechanical scrubbing strips the fragile periosteum and pushes dirt deeper into the porous cancellous bone marrow.
3. If you have a bottle or bag of sterile 0.9% normal saline (or clean potable bottled drinking water), you may gently pour a low-pressure stream over the wound to float away gross loose gravel or mud before laying your dressing on top.
4. Never pour hydrogen peroxide, rubbing alcohol, povidone-iodine (Betadine), chlorhexidine, or household soap into an open fracture. These antiseptics are toxic to osteoblasts and muscle cells and destroy the tissue's natural resistance to infection.
5. Apply the Two-Layer Open Fracture Dressing:
6. Layer 1 (Over the Bone): Lay a thick sterile gauze pad moistened with sterile normal saline gently over the exposed bone and open wound. (If you have no sterile saline, use a clean dry sterile non-adherent trauma dressing; never use fluffy cotton balls or paper tissues that shed lint into the bone.)
7. Layer 2 (Outer Protective Cover): Place a thick dry sterile abdominal (ABD) pad or multi-trauma dressing over the moist inner pad and the surrounding ring pad, then wrap roller gauze snugly around the limb to hold the dressing in place without pushing the bone inward.

Step 4: How to perform the Distal Neurovascular (PMS / CMS) Check¶

Every time you assess a fracture (before you touch or splint it, immediately after you tie the splint, and every 10 to 15 minutes until paramedics take over), you must check and document the PMS triad (Pulse/Perfusion, Motor function, and Sensation) in the hand or foot below the break.

Step 5: Splinting an open fracture safely (and when to realign a pulseless limb)¶

1. Golden Rule of Open Fracture Splinting: Splint the limb in the exact position found whenever a distal pulse is present.
2. Never try to straighten an angled open fracture just to make it fit neatly into a straight board splint. Straightening an open fracture pulls the contaminated bone end back under the skin.
3. Instead, use moldable splints (such as a padded SAM malleable aluminum splint, vacuum splint, pillow splint, or folded blankets/cardboard) molded to match the angle of the limb, and pad all hollow spaces generously with soft towels or clothing.
4. Immobilize the joint ABOVE and the joint BELOW the break: For an open lower-leg (tibia) fracture, the splint must immobilize both the ankle and the knee. For an open forearm fracture, immobilize both the wrist and the elbow.
5. Never tie a splint strap directly over the open fracture wound or protruding bone. Tie straps above and below the wound dressing, and leave the tips of the fingers or toes exposed so you can check PMS every 10 minutes.
6. The Single Exception: What if the hand or foot below the break is completely PULSELESS, cold, and pale/blue?
7. Occasionally, a severe ankle fracture-dislocation, tibial shaft fracture, or supracondylar elbow fracture twists at a 90-degree angle and kinks the main artery shut like a bent garden hose, threatening rapid death of the foot or hand and bursting of the tight stretched skin flap over the bone.
8. If EMS paramedics are only 5 to 10 minutes away: Leave the limb supported on pillows and let the arriving ALS paramedics administer intravenous analgesia and perform gentle inline realignment.
9. If the distal limb is completely pulseless, pale, and cold AND you are in a remote location or EMS transport is delayed (> 15 to 30 minutes): International trauma guidelines (ATLS, PHTLS, Wilderness Medical Society, UK NICE) authorize one gentle attempt at longitudinal inline traction realignment to un-kink the artery:
   1. Have one person steady the limb above the fracture while you hold the limb below the fracture with both hands.
   2. Aw bɛ inline traction kɛ ka ɲɛ, ka nɔgɔya, ka sabati (aw bɛ a sama dɔɔni dɔɔni kolotuguda jan fɛ) ka sɔrɔ ka bolokɔni min tigɛli jugumanba nɔgɔya dɔɔni dɔɔni ka segin ka taa farikolo yɔrɔ dɔ la min bɛ sɔrɔ a yɛrɛ la.
   3. AW YE YƆRƆBƆLI KƆRƆBƆLI ni aw ye kolotugudaw/kɔlɔsili ye masinw fɛ, ni dimi bɛ kɛ fɛn ye min tɛ se ka muɲu, walima ni aw ye kolo laban dɔ ye min bɔra kɛnɛ kan, o bɛ daminɛ ka segin ka segin fari jukɔrɔ.
   4. Aw bɛ sɔgɔsɔgɔninjɛ kɛ o cogo la ka segin ka yɔrɔjan sɔgɔsɔgɔninjɛ lajɛ o yɔrɔnin bɛɛ. (Ni sɔgɔsɔgɔninjɛ dɔ tun bɛ yen sanni aw ka sɔgɔsɔgɔninjɛ don, ka tunun aw ye sɔgɔsɔgɔninjɛ sirilen kɔfɛ, aw bɛ sɔgɔsɔgɔninjɛ sirilanw lajɔ o yɔrɔnin bɛɛ.)

Taabolo 6nan : Ni kolotuguda lajɔlen dɔ binna ka bɔ joginda la pewu ka taa duguma do?¶

Ni fanga caman bɛ sɔrɔ da wulilen karilenw na (marifa cilenw, motow tiɲɛni, walima izini masinw), kɔkolo kolo yɔrɔ dɔ min bɔra pewu, o bɛ se ka da siraba kan walima fini kan, a tigi kɛrɛfɛ. * Aw kana kolo yɔrɔ min bɔra a la, aw kana o fili abada, wa aw kana a ɲini abada k’a don joginda la ka segin a kan. * I n’a fɔ bolokɔni tigɛlen dɔ marali cogo min na a boloci min bɛ kɛ ni bɔnɛ ye, aw bɛ kolotuguda bɔlen siri gaze sterili la min mɔlen don ni saline normale sterili ye, ka a datugu bɔrɔ sanuman kɔnɔ min tɛ ji bɔ, ka a to a ka nɛnɛ (pake nɛnɛman dɔ kan min faralen don ɲɔgɔn kan ni fini barikalan ye walasa a kana nɛnɛ), ka tila k’a di kɛnɛyabaarakɛlaw ma walasa kolotugudaw operelikɛlaw ka se ka o fiɲɛ sɛgɛsɛgɛ walima ka baara kɛ n’a ye kolotuguda hakɛ la.

Kari dafalen ladonni teliya la, ni sterili ye, o bɛ nalomanya ni kolotugudaw bali a si bɛɛ la. Aw bɛ a lajɛ ka dɛmɛ fɔlɔ sɛbɛn, Stop the Bleed, walima kungo kɔnɔ jaabi fɔlɔ kalan kɛ aw ka jamana Croix Rouge walima Croix Rouge sosiyete fɛ, St John Ambulance fɛ, walima Ameriki operelikɛlaw ka kolɛji fɛ.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Sosow sɛgɛsɛgɛra¶

• Amerika ka operelikɛlaw ka kalanso (ACS, Ameriki): Advanced Trauma Life Support (ATLS) kalandenw ka kalan gafe: Farikolo ni kolotugudaw jogin, kari dafalenw, ani hakili ni jolisiraw jateminɛ.
• British Orthopedic Association (BOA) & British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS, Angletɛri): BOAST ka laadilikanw: Jateminɛ sariyaw ka ɲɛsin joginda ma: Kari dafalenw.
• Jamana ka kɛnɛyako ni ladonniko ɲɛtaa baarada (NICE, Angletɛri): Ladilikan NG37: Kariw (Complex): Kari dafalenw jateminɛni ni u ɲɛnabɔli kɛnɛyaso ɲɛfɛ ani dɔgɔtɔrɔso sigidaw la.
• American Academy of Orthopaedic Surgeons (AAOS) & Orthopaedic Trauma Association (OTA, Etazuni): Dɔgɔtɔrɔso ka baarakɛcogo ɲɛfɔli opereli yɔrɔ banakisɛw kunbɛnni kan, a jugumanba kɔfɛ.
• Wilderness Medical Society (WMS, Etazuni): Dɔgɔtɔrɔso baarakɛcogo laadilikanw ka ɲɛsin kari dafalenw ni karilenw furakɛli jɔnjɔn ma sigida gɛlɛnw na.

Gafe minnu bɛ tali kɛ o ko la¶

• Kolow karilen, kari, ani kurukuruw dɛmɛ fɔlɔ
• Joli jugumanba kunbɛnni ani tourniquets
• Crush joginni ni compartiment syndrome dɔnni
• Kamankun, gɛnɛgɛnɛ ani kolotugudaw lamagacogo
• Impalement ani embedded dunan fɛnw sabatili
• Kɔrɔtɔko nimɔrɔw ani jamana wɛrɛw ka cikanw