General Principles of Fracture Treatment
Improvised Splinting
Wilderness Medicine Institute of NOLS
Workshop Notes: Improvised Splinting. July 27, 2005
Wilderness Medical Society Conference and Annual Meeting.
Context: Managing fractures in remote environments requires common sense,
consideration of a few simple principles and creative use of available materials. We
assume our wilderness expedition does not have an elaborate medical kit. We'll need
to immobilize the injury with a split that protects the injury yet is not too bulky or heavy,
after all, we may have to carry this patient. As well the splint will need to be
comfortable, adjustable and insulate against cold.
Treatment Principles for Fractures and Unusable Musculoskeletal Injury
1. Assess the injury: Check CSM.
2. Use gentle traction-in-line (TIL) to establish normal anatomical position.
3. Slow or discontinue if pain increases significantly or you meet resistance.
4. Splint in a position of function. A splint should be:
·
Padded, but not bulky or heavy
·
Rigid
·
Adjustable
·
Fingers/toes accessible for assessment
·
Immobilize the joint above and below long bone injuries
·
Immobilize the bones above and below a joint injury.
5. RICE, pain medication as needed.
6. Splint mid-shaft femoral fractures with traction.
7. Monitor CSM before and after TIL and splinting.
8. Evacuate.
Rigid splinting materials typically found on backcountry trips include: stays from packs,
Crazy Creek Chairs®, sticks, sleeping pads, etc. Therm-A-Rest® pads offer an
advantage: They can be deflated, secured in place, then inflated for additional rigidity.
Commercial splints of practical value for some broken bones in wilderness situations
include the SAM Splint® and foldable wire splints.
Most upper extremity fractures can be adequately immobilized with a sling and swathe.
Sling and swathe can be made from triangular bandages, or a variety of improvised
techniques. A shirt, for instance, can be formed into a sling using the arms of the shirt to
go around the patient's neck. You can cut strips from the bottom of a shirt to use as
swathes. A shirt can be used as a sling by putting the patient's head through the head-
hole on the shirt and using the arm-holes to hold the patient's arm. As a minimal sling
and swathe, you can fold up the bottom of the shirt the patient is wearing and safety pin
it in place for a sling, and zip a jacket closed over the torso as a swathe.
Most lower extremity fractures can be immobilized with sleeping pads held firmly in place
with elastic wraps, triangular bandages, belts, rope, strips of cloth. In the absence of
sleeping pads, lower extremities can be splinted with paddles, ski poles, ice axes, sticks,
etc., and adequate padding.
Workshop Plan:
