1-9

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1-9. GENERAL PRINCIPLES FOR TREATING FRACTURES

Fractures may be discovered either during the primary or secondary survey of the casualty. Take measures to maintain or restore breathing and heartbeat, control major bleeding, and control shock before treating a fracture. The general procedures for treating a fracture of an extremity (arm or leg) are given below.

NOTE: Procedures for restoring breathing and heartbeat are given in Subcourse

MD0532, Cardiopulmonary Resuscitation. Procedures for controlling external

and internal bleeding and controlling shock are given in Subcourse MD0554,

Treating Wounds in the Field. Procedures for treating a spinal fracture are

given in Lesson 2 of this subcourse.

CAUTION: Do not move the casualty before splinting the fracture unless you must

remove the casualty (and yourself) from immediate danger (escape from

a burning vehicle, move out of the line of fire, and so forth).

a. Reassure Casualty. Tell the casualty that you will take care of him.

b. Expose the Limb. If you suspect the casualty has a fractured limb, gently remove the casualty's clothing from the injured limb and check for signs of a fracture. Loosen any clothing that is tight or binds the casualty. DO NOT remove the casualty's boots.

CAUTION: Do not expose the limb if you are in a chemical environment (chemical

agents are present and the "all clear" signal has not been given).

c. Locate Site of Fracture. The site of the fracture is normally found by identifying the site of the deformity, false motion, bruise, wound, and/or point tenderness. To determine point tenderness in a conscious casualty, gently palpate the area with your fingers to determine the location of maximum discomfort.

d. Remove Jewelry, If Appropriate. If the casualty has a suspected fracture of the arm, remove any jewelry on the injured arm and put the jewelry in the casualty's pocket. If the limb swells, the jewelry may interfere with blood circulation. The jewelry may then have to be cut off to restore adequate blood circulation.

e. Assess Distal Neurovascular Function. Check for impairment of the nerves and/or circulatory system below the site of the suspected fracture. Some of the methods used to identify impairment are given below.

(1) Check pulse. Palpate a pulse site below the fracture site. If no pulse or a weak pulse is found, the fracture may be putting pressure on the artery or may have damaged the artery. A weak pulse can be determined by comparing the pulse felt below the fracture with the pulse felt at the same location on the uninjured limb. A casualty with no pulse below the fracture site should be evacuated as soon as the limb is splinted.

 

(2) Check capillary refill. If the fractured limb is an arm, press on the casualty's fingernail, then release. If normal color does not return within two seconds, the limb may have impaired circulation. This is also called the blanch test.

 

(3) Check skin temperature. Touch the casualty's skin below the fracture. Coolness may indicate decreased or inadequate circulation. Compare the temperature of the injured limb to the temperature of the same area on the uninjured limb.

 

(4) Check sensation. Ask a conscious casualty if he can feel your touch. Then lightly touch an area below the fracture. For example, if his arm is fractured, touch the tip of the index and little fingers on the injured arm. Ask the casualty if the injured limb feels numb or has a tingling sensation.

 

(5) Check motor function. Ask a conscious casualty to try opening and closing the hand of an injured arm or moving the foot of an injured leg. If the attempt produces pain, have the casualty stop his efforts.

f. Dress Wounds. If the fracture is open, apply a field dressing or improvised dressing the wound before splinting the limb. Do not attempt to push exposed bone back beneath the skin. If the bone slips back spontaneously, make a notation of the fact on the casualty's U.S. Field Medical Card (FMC). The card is initiated after treatment is completed and accompanies the casualty to the medical treatment facility.

g. Immobilize Fracture. Immobilize the fracture to relieve pain and to prevent additional damage to tissues at the fracture site due to movement of the fractured bone(s). If an extremity is fractured, apply a splint using the following general rules.

CAUTION: The general principle is "splint the fracture as it lies." Do not reposition

the fracture limb unless it is severely angulated and it is necessary to

straighten the limb so it can be incorporated into the splint. If needed,

straighten the limb with a gentle pull.

(1) If the fracture site is not on a joint, immobilize the joint above the fracture site and the joint below the fracture site.

 

(2) If a joint is fractured, apply the splint to the bone above the joint and to the bone below the joint so the joint is immobilized.

 

(3) Pad the splint at the joints and at sensitive areas to prevent local pressure.

 

(4) Minimize movement of the limb until it has been splinted.

(a) If the shaft of a long bone is fractured and severely deformed, apply gentle manual traction to attempt to align the limb so it can be splinted.

 

(b) If resistance is encountered when manual traction is applied, stop your efforts and splint the limb in the position of deformity.

 

NOTE: If the femur is fractured, a traction splint is available, and sufficient personnel

are available, apply the traction splint to the leg using the procedures given in

Lesson 3 of this subcourse.

(5) Secure the splint above and below the fracture site.

(a) Recheck the pulse below the securing device (cravat, strap, or other material) each time a securing device is applied. If the device interferes with blood circulation, loosen and retie the securing material.

 

(b) Never apply a cravat or other securing material directly over the fracture site.

(6) If you are in doubt as to whether an extremity does or does not have a fracture, splint the extremity.

h. Check Distal Neurovascular Function. Check again for impairment of the nerves and/or circulatory system below the site of the fracture using the procedures listed in paragraph e on the previous page.

i. Evacuate the Casualty. Evacuate the casualty to a medical treatment facility. If you cannot detect a pulse below the fracture site, evacuate the casualty as soon as possible in an effort to save the limb.

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