Procedures for Splinting Suspected Fractures

Before beginning first aid treatment for a fracture, gather whatever splinting materials are available. Materials may consist of splints, such as wooden boards, branches, or poles. Other splinting materials include padding, improvised cravats, and/or bandages. Ensure that splints are long enough to immobilize the joint above and below the suspected fracture. If possible, use at least four ties (two above and two below the fracture) to secure the splints. The ties should be nonslip knots and should be tied away from the body on the splint.

*a. Evaluate the Casualty (081-831-1000). Be prepared to perform any necessary lifesaving measures. Monitor the casualty for development of conditions which may require you to perform necessary basic lifesaving measures. These measures include clearing the airway, rescue breathing, preventing shock, and/or bleeding control.

Unless there is immediate life-threatening danger, such as a fire or an explosion, DO
NOT move the casualty with a suspected back or neck injury. Improper movement
may cause permanent paralysis or death.

In a chemical environment, DO NOT remove any protective clothing. Apply the dressing/splint over the clothing.

b. Locate the Site of the Suspected Fracture. Ask the casualty for the location of the injury. Does he have any pain? Where is it tender? Can he move the extremity? Look for an unnatural position of the extremity. Look for a bone sticking out (protruding).

c. Prepare the Casualty for Splinting the Suspected Fracture (081-831-1034).

(1) Reassure the casualty. Tell him that you will be taking care of him and that medical aid is on the way.

(2) Loosen any tight or binding clothing.


(3) Remove all the jewelry from the casualty and place it in the casualty's pocket. Tell the casualty you are doing this because if the jewelry is not removed at this time and swelling occurs later, further bodily injury can occur.

Boots should not be removed from the casualty unless they are needed to stabilize a
neck injury, or there is actual bleeding from the foot.

d. Gather Splinting Materials (081-831-1034). If standard splinting materials (splints, padding, cravats, and so forth) are not available, gather improvised materials. Splints can be improvised from wooden boards, tree branches, poles, rolled newspapers or magazines Splints should be long enough to reach beyond the joints above and below the suspected fracture site. Improvised padding, such as a jacket blanket, poncho, shelter half, or leafy vegetation may be used. A cravat can be improvised from a piece of cloth, a large bandage, a shirt, or a towel. Also, to immobilize a suspected fracture of an arm or a leg, parts of the casualty's body may be used. For example, the chest wall may be used to immobilize an arm; and the uninjured leg may be used to immobilize the injured leg.

If splinting material is not available and suspected fracture CANNOT be splinted,
then swathes, or a combination of swathes and slings can be used to immobilize an
extremity.

e. Pad the Splints (081-831-1034). Pad the splints where they touch any bony part of the body, such as the elbow, wrist, knee, ankle, crotch, or armpit. Padding prevents excessive pressure to the area.

f. Check the Circulation Below the Site of the Injury (081-831-1034).

(1) Note any pale, white, or bluish-gray color of the skin which may indicate impaired circulation. Circulation can also be checked by depressing the toe/fingernail beds and observing how quickly the color returns. A slower return of pink color to the injured side when compared with the uninjured side indicates a problem with circulation. Depressing the toe/fingernail beds is a method to use to check the circulation in a dark-skinned casualty.

(2) Check the temperature of the injured extremity. Use your hand to compare the temperature of the injured side with the uninjured side of the body. The body area below the injury may be colder to the touch indicating poor circulation.

(3) Question the casualty about the presence of numbness, tightness, cold, or tingling sensations.

Casualties with fractures to the extremities may show impaired circulation, such as numbness, tingling, cold and/or pale to blue skin. These casualties should be
evacuated by medical personnel and treated as soon as possible. Prompt medical
treatment may prevent possible loss of the limb.

If it is an open fracture (skin is broken; bone(s) may be sticking out), DO NOT
ATTEMPT TO PUSH BONE(S) BACK UNDER THE SKIN. Apply a field
dressing to protect the area. See Task 081-831-1016, Put on a Field or Pressure
Dressing.

g. Apply the Splint in Place (081-831-1034).

(1) Splint the fracture(s) in the position found. DO NOT attempt to reposition or straighten the injury. If it is an open fracture, stop the bleeding and protect the wound. (See Chapter 2, Section II, for detailed information.) Cover all wounds with field dressings before applying a splint. Remember to use the casualty's field dressing, not your own. If bones are protruding (sticking out), DO NOT attempt to push them back under the skin. Apply dressings to protect the area.

(2) Place one splint on each side of the arm or leg. Make sure that the splints reach, if possible, beyond the joints above and below the fracture.

(3) Tie the splints. Secure each splint in place above and below the fracture site with improvised (or actual) cravats. Improvised cravats, such as strips of cloth, belts, or whatever else you have, may be used. With minimal motion to the injured areas, place and tie the splints with the bandages. Push cravats through and under the natural body curvatures (spaces), and then gently position improvised cravats and tie in place. Use nonslip knots. Tie all knots on the splint away from the casualty (Figure 4-2). DO NOT tie cravats directly over suspected fracture/dislocation site.

h. Check the Splint for Tightness (081-831-1034). (1) Check to be sure that bandages are tight enough to securely hold splinting materials in place, but not so tight that circulation is impaired. (2) Recheck the circulation after application of the splint. Check the skin color and temperature. This is to ensure that the bandages holding the splint in place have not been tied too tightly. A finger tip check can be made by inserting the tip of the finger between the wrapped tails and the skin. (3) Make any adjustment without allowing the splint to become ineffective. i. Apply a Sling if Applicable (081-831-1034). An improvised sling may be made from any available nonstretching piece of cloth, such as a fatigue shirt or trouser, poncho. or shelter half. Slings may also be improvised using the tail of a coat, belt, or a piece of cloth from a blanket or some clothing. See Figure 4-3 for an illustration of a shirt tail used for support. A pistol belt or trouser belt also may be used for support (Figure 4-4). A sling should place the supporting pressure on the casualty's uninjured side. The supported arm should have the hand positioned slightly higher than the elbow.

(1) Insert the splinted arm in the center of the sling (Figure 4-5).

(2) Bring the ends of the sling up and tie them at the side (or hollow) of the neck on the uninjured side (Figure 4-6).

(3) Twist and tuck the corner of the sling at the elbow (Figure 4-7).

j. Apply a Swathe if Applicable (081-831-1034). You may use any large piece of cloth, such as a soldier's belt or pistol belt, to improvise a swathe. A swathe is any band (a piece of cloth) or wrapping used to further immobilize a fracture. When splints are unavailable, swathes, or a combination of swathes and slings can be used to immobilize an extremity. WARNING (081-831-1034) The swathe should not be placed directly on top of the injury, but positioned either above and/or below the fracture site. (1) Apply swathes to the injured arm by wrapping the swathe over the injured arm, around the casualty's back and under the arm on the uninjured side. Tie the ends on the uninjured side (Figure 4-8).

(2) A swathe is applied to an injured leg by wrapping the swathe(s) around both legs and securing it on the uninjured side. k. Seek Medical Aid. Notify medical personnel, watch closely for development of life-threatening conditions, and if necessary, continue to evaluate the casualty.