If a fracture is suspected, don’t move the injured area — keep it supported and apply cold for up to 20 minutes; never try to realign it yourself.

41. If a fracture is suspected, don’t move the injured area — keep it supported and apply cold for up to 20 minutes; never try to realign it yourself.

Cost: No cost involved. Use a stiff board, rolled‑up magazines, or clothing as a splint. Wrap cold items in a cloth before applying them.

In plain terms: Any injury to a limb should be treated as a possible fracture at first — being able to stand or move does not rule it out; only an X‑ray can confirm it. Keep the injured part still, supporting it with your hand or using a triangular bandage or rigid splint to hold it in its original position. Apply cold as soon as possible, but never for more than 20 minutes at a time. Do not attempt to realign the bone yourself. For open fractures where bone pierces the skin, first stop any bleeding and cover the wound with a clean dressing; do not push the bone back into place.

Benefit: The International Federation of Red Cross and Red Crescent Societies released its 2025 International First Aid Guidelines, which state that “any injury to a limb should be treated as a possible fracture” and “the only reliable way to confirm a fracture is an X‑ray; when in doubt, treat it as a fracture.” The purpose of immobilisation is “to minimise movement and pain.” Cold application “should be limited to 20 minutes at a time to reduce pain; longer exposure can damage the skin.” “For long bones such as the femur, bleeding from the bone itself can be life‑threatening.” Call emergency services if there is significant pain or swelling, signs of shock, a suspected femoral fracture, or obvious deformity of the limb. Only under two specific conditions may a fractured bone be manually realigned on site: first, when help is far away (or resources are limited) and the part of the limb below the angle appears cold and pale, or when the rescuer cannot safely immobilise it for transport; second, only if the rescuer is properly trained. For open fractures, the priority is stopping bleeding and preventing infection.

Evidence grade: B

Sources: International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025, pp. 301–302. <https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf>

Notes: This grade B rating reflects that these practices are widely accepted. There is only one older study supporting the use of traction immobilisation for femoral fractures before hospital care; its reliability is low, yet it shows modest benefits such as reduced blood loss within 24 hours, shorter hospital stays, and no meaningful difference in mortality or complications. No evidence exists regarding whether early realignment yields any advantage over simple immobilisation. Three common misconceptions should be corrected: being able to walk does not rule out a fracture; cold alone — not alternating hot and cold — is appropriate; and sprains do not “work themselves out” with movement; rest is essential. For elderly patients with suspected fractures after a fall, refer to item 2 for handling precautions. Swelling of one leg after casting or bed rest may indicate a clot; see item 11 for details. Information on disability assessment and eligibility for a disability certificate after treatment can be found in section 24, items 10 and 11.