How to Splint an Extremity in the Wilderness
Sustaining an extremity long bone fracture in remote conditions presents unique challenges. Without immediate access to advanced medical care, it is crucial to properly immobilize the fracture to reduce the risk of further injury, promote healing, and prevent long-term disability. Here are the essential steps to splint a fracture when definitive medical care is not readily available:
1. Perform a thorough physical examination of the patient, assessing for signs of open fractures, neurovascular compromise, and additional injuries. Examine the injured extremity closely for deformity, swelling, bruising, and tenderness.
2. Ensure that the patient has a distal pulse, capillary refill, sensation, as well as the ability to move their fingers/toes under their own power to ensure that the extremity is adequately perfused. The acronym CMS (Circulation, Motor, and Sensory) is a helpful tool to assist providers in remembering this important step. This step needs to be reassessed after intervention is complete.
3. Assemble splinting materials using available resources such as sticks, cloth, rope, tape, padding, and anything that can create a rigid structure to immobilize the fracture. The goal is to restrict movement and stabilize the broken bone.
4. Pad areas around the fracture with soft material to cushion bony prominences and reduce the chance of pressure sores or nerve injuries developing. Clothing, towels, foam, and other padding can be used.
5. Immobilize the joint above and below the fracture site. For example, if the fracture is in the radius bone of the forearm, splint the wrist and elbow joints to fully immobilize the forearm.
6. Secure the splint tightly but not constrictively using straps, tape, or knots. Check for proper distal circulation by feeling for a pulse, assessing skin color and temperature, and evaluating capillary refill.
7. Elevate the injured extremity above the level of the heart to reduce swelling. Apply ice intermittently for the first 24-48 hours if possible to decrease inflammation.
8. Closely monitor the patient and record trends in condition, worsening neurovascular function, compartment syndrome, and other complications that may require emergency medical intervention. Continue to provide pain management, psychological support, and hygiene care during the wait for definitive treatment.
Conclusion
With careful splinting, proper patient positioning, and vigilant monitoring in austere environments, extremity fractures can be initially managed to optimize healing, restore function, and prevent long-term impairment until advanced medical care becomes available. Utilizing the proper splinting techniques is crucial to achieve the best possible outcome.
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