4-6. Procedures for Splinting Suspected Fractures

Table of Contents

Before beginning first aid procedures for a fracture, gather whatever splinting materials are available. 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 square knots and should be tied away from the body on the splint. Distal pulses of the affected extremity should be checked before and after the application of the splint.

• a. Evaluate the Casualty. Be prepared to perform any necessary lifesaving measures. Monitor the casualty for development of conditions that may require you to perform necessary lifesaving measures.

WARNING

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.

WARNING

In a chemical environment, DO NOT remove any protective clothing. Apply the dressings and splints over the garments.

• b. Locate the Site of the Suspected Fracture.
• • (1) Ask the casualty for the location of the injury.
  • • • Does he have any pain?
    • • Where is it tender?
    • • Can he move the extremity?

NOTE

With the presence of an obvious deformity, do not make the casualty move extremity.

• • (2) Look for an unnatural position of the extremity.
  • (3) Look for a bone sticking out (protruding).
• c. Prepare the Casualty for Splinting the Suspected Fracture.
• • (1) Reassure the casualty. Tell him that you will be providing first aid for him and that medical help is on the way.
  • (2) Loosen any tight or binding clothing.
  • (3) Remove all jewelry from the injured part and place it in the casualty’s pocket. Tell the casualty you are doing this because if the jewelry is not removed and swelling occurs later, he may not be able to get it off and further bodily injury could result.
  • (4) 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. If standard splinting materials (splints, padding, and cravats) are not available, gather improvised materials. If splinting material is not available and the suspected fracture CANNOT be splinted, then swathes, or a combination of swathes and slings can be used to immobilize the extremity.
• e. Pad the Splints. Pad the splints where they touch any bony part of the body, such as the elbow, wrist, knee, ankle, crotch, or armpit areas. Padding prevents excessive pressure on the area, which could lead to circulation problems.
• f. Check the Circulation Below the Site of the Injury.
• • (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 or fingernail beds and observing how quickly the color returns. A slower return of color to the injured side when compared with the uninjured side indicates a problem with circulation. The fingernail bed is the 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. 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.

WARNING

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

WARNING

If it is an open fracture and the bone is protruding from the skin, DO NOT ATTEMPT TO PUSH THE BONE BACK UNDER THE SKIN. Apply a field dressing over the wound to protect the area.

• g. Apply the Splint in Place.
• • (1) Splint the fracture 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. Cover all wounds with field dressings before applying a splint. Remember to use the casualty’s field dressing, not your own.
  • (2) Place one splint on each side of the fracture. 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, and then gently position improvised cravats and tie in place. Use square knots. Tie all knots on the splint away from the casualty (Figure 4-2). DO NOT tie cravats directly over the suspected fracture site.

Figure 4-2. Square knots tied away from casualty.

• h. Check the Splint for Tightness.
• • (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 fingertip check can be made by inserting the tip of the finger between the bandaged knot and the skin.
  • (3) MAKE any necessary adjustment without allowing the splint to become ineffective.
• i. Apply a Sling. An improvised sling may be made from any available nonstretching piece of cloth, such as a battle dress uniform (BDU) shirt or trousers, poncho, or shelter half. Slings may also be improvised using the tail of a coat, belt, or a piece of cloth. Figure 4-3 depicts a shirttail used for support. A trousers belt or LBE may also 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 showing the fingers.

Figure 4-3. Shirttail used for support.

Figure 4-4. Belt used for support.

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

Figure 4-5. Arm inserted in center of improvised sling.

• • (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).

Figure 4-6. Ends of improvised sling tied to side of neck.

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

Figure 4-7. Corner of sling twisted and tucked at elbow.

• j. Apply a Swathe. You may use any large piece of cloth, service member’s belt, or pistol belt, to improvise a swathe.

WARNING

The swathe should not be placed directly on top of the injury, but positioned either above 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).

Figure 4-8. Arm immobilized with strip of clothing.

• • (2) A swathe is applied to an injured leg by wrapping the swathe around both legs and securing it on the uninjured side.
• k. Seek Medical Assistance. Notify medical personnel, watch closely for development of life-threatening conditions and/or impaired circulation to the injured extremity. (Refer to Chapter 1 for additional information on life-threatening conditions.)