LESSON 12
PERFORM FIRST AID FOR A SUSPECTED FRACTURE
(TASK 081-831-1034)

TASK:

Identify the procedures for identifying and immobilizing a suspected fracture of the spine, arm, or leg.

CONDITIONS:

Given multiple-choice examination items pertaining to treating fractures.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCES:

STP 21-1-SMCT, Soldiers Manual of Common Tasks: Skill Level 1.
FM 21-11, First Aid for Soldiers.

NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.

12-1. INTRODUCTION

A fracture is a break in a bone. A fracture can cause discomfort, disability, and even death.

FIGURE 12-1. EXAMPLES OF FRACTURES

A closed fracture is a break in the bone without a break in the skin. Even though the skin is not cut or broken, the tissue beneath the skin may be damaged.

An open fracture is a break in the bone with a break in the overlying skin as well. The break in the skin may be caused by the sharp end of the broken bone or by a foreign object such as a bullet penetrating the skin. Open fractures are especially serious due to the danger of infection.

A dislocation occurs when the bones comprising a joint (elbow, knee, wrist, etc.) are forced out of their proper positions. A sprain results when a joint is twisted beyond its normal limits of motion and the connecting tissues around the joint tear. A dislocation or sprain can produce signs and symptoms similar to those of a fracture and should be treated as a fracture of the joint.

12-2. IDENTIFY SIGNS AND SYMPTOMS OF A FRACTURED SPINE

FIGURE 12-2. SPINAL COLUMN

The spinal column (also called the backbone or spine) consists of a series of bones called vertebrae. The top seven vertebrae are the bones of the neck. The spinal column surrounds and protects the spinal cord. The spinal cord consists of nerves which carry impulses between the brain and the rest of the body. If the spinal cord is severed (cut completely), the muscles controlled by the portion of the spinal cord below the cut will not function. Always check for a spinal injury if the casualty has suffered a fall or has been hit in the back.

Signs and symptoms of an injured spine include:

12-3. IMMOBILIZE A FRACTURED SPINE

Treat any casualty which you think may have a spinal injury as though you were certain that he had a fractured spine.

Tell the casualty to keep still. Any movement could cause additional injury.

Send someone to get medical help.

If the casualty is lying on his stomach, keep him from moving until medical help arrives. If the casualty is lying on his back, use padding to help immobilize his back, neck, and head as described in the following pages.

Roll or fold padding (such as a blanket) so that it conforms to the shape of the arch of his back. Then carefully slide the padding under the arch of his back. This padding will help to support and immobilize his back.

Slide a roll of cloth under the casualty's neck to help support and immobilize his neck.

FIGURE 12-3. PADDING PLACED UNDER BACK AND NECK

Place padded rocks, small padded logs, or filled boots on each side of the casualty's head to keep it from moving.

FIGURE 12-4. IMMOBILIZING THE HEAD WITH BOOTS

To Prepare filled boots:

Fill the boots almost to the top with sand or small rocks.

Place material (strip of clothing, sock, etc.) on top of the sand or rocks to keep the sand or rocks from falling out.

Tie the top of the boots to keep the material from coming out.

Place the boots around the casualty's head.

12-4. IDENTIFY SIGNS AND SYMPTOMS OF A FRACTURED ARM OR LEG

Some of the signs and symptoms of a fractured arm or leg are given below.

Bone sticking through the skin.

Feeling what appears to be a break in the bone.

Pain, tenderness, swelling, and/or bruises at a particular location. (The site of the tenderness or bruise is probably the site of the fracture.)

Arm or leg in an abnormal position (looks deformed).

Difficulty in moving an arm or leg. (NOTE: Do not have the casualty attempt to move the injured arm or leg to test this symptom. Rely upon what the casualty tells you.)

Massive injury to an arm or leg. (Even if the arm or leg is not broken, the pain caused by the wound may be lessened if the arm or leg is splinted after it has been dressed and bandaged.)

"Snapping" sound heard by the casualty at the time of the injury.

12-5. PREPARE THE CASUALTY PRIOR TO SPLINTING

Once you have located the site of the fracture, you must splint the injured arm or leg. (A splint is a rigid object or objects secured to the injured limb so as to prevent the broken bone from moving. If the fractured bone is not splinted, the sharp end of the broken bone could move and injure surrounding muscles, blood vessels, and nerves.) Before applying the splint, however, you should prepare the casualty.

Reassure Casualty

Tell the casualty that you are taking care of him. If you must leave the casualty to locate a rigid object or securing materials, be sure to tell him that you will return quickly. Talk to the casualty even if he appears to be unconscious.

Loosen Clothing

Loosen any clothing that is tight or which binds the casualty. Boots should not be removed unless they are needed to immobilize an injured neck or there is bleeding from the foot.

Remove Jewelry

Remove any jewelry that is on the casualty's injured limb and put the jewelry into his pocket. Jewelry is removed because the limb may swell and cause the jewelry to interfere with blood circulation. Be sure to tell the casualty what you are doing and why.

Check Circulation Below Fracture

Evaluate the casualty's blood circulation in the limb below the fracture site. A person with poor circulation should be evacuated as soon as possible after the limb is splinted. A quick evacuation will help to prevent the loss of the limb.

Numbness. If the area feels numb or tingling to the casualty, the area probably has poor circulation.

Color. In a light-skinned person, a pale, white, or bluish-gray skin color indicates poor circulation. To check the circulation in a dark-skinned individual, press on a nail on the injured limb and the corresponding nail on the uninjured arm or leg. Release both nails at the same time. If the color returns to the nail bed of the uninjured limb faster than it returns to the nail bed of the injured limb, the casualty probably has poor circulation in the injured limb.

Temperature. Place your hand on the area beneath the injury. Then place your hand on the corresponding area on the uninjured arm or leg. If the skin of the injured limb is cooler that the skin on the uninjured limb, the casualty probably has poor circulation in the injured limb.

Dress Wounds

Dress any open wounds on the injured limb before applying the splint. If a bone is sticking out, do not attempt to push the bone back under the skin. Apply the dressing over the bone and the wound. Do not attempt to straighten or realign the injured limb.

12-6. PREPARE THE SPLINT

Gather Materials

Gather the materials you will need to make the splint. You will need something to use as the rigid object, padding, and securing material to keep the splint from slipping.

Rigid Object. Tree branches, poles, boards, sticks, unloaded rifles, or other rigid objects can be used. Normally, two rigid objects (one for each side of the limb) are used. The rigid objects should be fairly straight and be long enough to extend beyond the joint above the fracture site and beyond the joint below the fracture site. Even the casualty's own body can be used when other materials are not available. His chest can be used to immobilize a fractured arm and an uninjured leg can be used to immobilize a fractured leg.

Padding. Blankets, jackets, ponchos, extra clothing, shelter halves, or leafy plants can be used to pad the splint. In some cases, you may have to use the casualty's trouser leg or shirt sleeve as padding. Padding is necessary to keep the rigid object from rubbing against the skin on the injured limb.

Securing Materials. Rigid objects can be secured with strips of clothing, belts, pistol belts, bandoleers, cravats, or similar materials. Cravats are preferred when possible. Narrow materials such as wire and cord should not be used to secure the rigid object in place since they could interfere with blood circulation. The steps for making cravats are summarized below.

• Cut or tear a square about three feet on each side from pliable material such as a shirt or sheet.
• Fold the square along the diagonal so that it is triangular in shape.
• Cut or tear along the fold so that two triangles are formed. (Each triangle becomes a cravat.)
• Fold top of the triangle down until the tip of the triangle touches the base (longest side).
• Continue to fold until the cravat is of the correct size.

Position the Rigid Objects

Place the rigid objects so that one is on each side of the injured limb. When possible, position the rigid objects so that the joint above the fracture and the joint below the fracture can be immobilized. If the fracture is in the lower leg, for example, the splint should extend above the knee and below the ankle. (Note: If a forearm is fractured, the wrist is usually immobilized by the splint and the elbow is usually immobilized by a sling and swathe.) Make sure that the ends of the rigid objects are not pressing against a sensitive area such as the armpit or groin. Pressure on these areas can interfere with blood circulation.

Apply Padding

Place padding between the rigid objects and the body part to be splinted. The padding helps to prevent excessive pressure on the limb which could interfere with blood circulation. Extra padding should be used at bony body areas such as the elbow, wrist, knee, or ankle and extra-sensitive areas such as the groin and armpit.

12-7. APPLY THE SPLINT

Position the securing materials. Push the securing material (cravat, etc.) under natural body curvatures, such as the knee. Then gently move the securing material up or down the limb until the material is in proper position.

Place securing material under the limb both above and below the fracture site. If possible, place two cravats above the fracture site and two cravats below the fracture site (above the upper joint, between the upper joint and the fracture, between the fracture and the lower joint, and below the lower joint.)

Place the padded rigid objects on the securing materials and against the injured limb.

Wrap the securing materials around the rigid objects and limb so that the rigid objects immobilize the limb. Tie the ends (tails) of each securing cravat in a nonslip knot on the outer rigid object and away from the casualty. (The knots are tied on the outer rather than the inner rigid object to make loosening and retying the cravats easier should that procedure become necessary.) The securing material should be tight enough to hold the rigid objects securely in place, but not tight enough to interfere with blood circulation.

FIGURE 12-5. SINGLE-BOARD SPLINT APPLIED TO A FRACTURED WRIST

FIGURE 12-6. SPLINT APPLIED TO A FRACTURED FOREARM

FIGURE 12-7. SPLINT APPLIED TO A FRACTURED ELBOW

FIGURE 12-8. CHEST USED AS SPLINT FOR AN UPPER ARM FRACTURE

FIGURE 12-9. SPLINT APPLIED TO A FRACTURE OF THE UPPER LEG (THIGH)

FIGURE 12-10. SPLINT APPLIED TO A FRACTURED KNEE (BENT)

FIGURE 12-11. UNINJURED LEG USED AS A SPLINT

Observe the limb below the cravats for signs of impaired circulation as you secure the splints. After the splint has been secured, recheck the limb's circulation to ensure that the cravats or rigid objects have not interfered with blood circulation. Check the color and temperature of the limb and ask the casualty how the limb feels. If your check before splinting the fracture showed normal circulation and your check now shows poor circulation (bluish skin, slow return of color to nail bed, coolness, or a numb or tingling sensation in the limb), take the following measures to restore circulation.

• Loosen the securing strips/cravats.
• If the end of the rigid object is pressing against the casualty's body (especially under the arm or inside the thigh), reposition the rigid object and/or add padding.
• Retie the securing materials using nonslip knots on the outer rigid object. Make sure that the securing materials keep the rigid objects from slipping, but are not tight enough to interfere with blood circulation.
• Recheck the circulation. If the limb still has poor circulation, evacuate the casualty as soon as possible.

12-8. APPLY A SLING TO A FRACTURED ARM

A sling can be used to support an injured arm with a fractured forearm, wrist, or hand. When the upper arm is fractured, a sling can be used to help immobilize the forearm and elbow. Apply and secure padded rigid objects to immobilize the fracture before applying the sling. (NOTE: If the chest is to be used as the rigid object, apply the sling before securing the upper arm to the chest with swathes.)

A sling can be made using a triangular bandage, strips of torn material, or the casualty's shirt or jacket.

Triangular Bandage Sling

A triangular bandage sling can be made from any available nonstretching material such as a muslin bandage, fatigue shirt, trousers, poncho, blanket, or shelter-half.

FIGURE 12-12. APPLYING A TRIANGULAR BANDAGE SLING

Cut or tear the material into a triangular shape (same as making a cravat).

Insert the material under the injured arm so that the arm is in the center of the material, the apex of the sling is beyond the elbow, and the top corner of the material is over the shoulder of the injured side.

Position the forearm so that the hand is slightly higher than the elbow (at about a 10 degree angle).

Bring the lower portion of the material over the injured arm so that the bottom corner goes over the shoulder of the uninjured side.

Bring the top corner behind the casualty's neck.

Tie the two corners together so that the knot will not slip. The knot should fit into the "hollow" at the side of the neck on the uninjured side. (If the right arm is fractured, for example, tie the knot so that it will rest in the hollow on the left side of his neck.)

Twist the apex of the sling and tuck it in at the elbow. (The corner can also be secured using a safety pin.) This secures the elbow and keeps the forearm from slipping out of the sling.

Jacket Flap Sling

Position the forearm on the casualty's chest with the hand positioned slightly higher than the elbow.

Undo the jacket so that the lower portion (flap) can be brought over the arm to form a sling.

Bring the flap up over the forearm to the pocket area. Position the elbow so that it is inside the sling and will not slip out of the sling.

Push a stick or other rigid object through the flap and the upper portion of the jacket so the flap will not slip.

FIGURE 12-13. BDU JACKET FLAP SLING

12-9. APPLY A SWATHE TO A FRACTURED ARM

A swathe is a band or wrapping used to further immobilize an arm once the fracture has been splinted. A large strip of cloth, blanket strip, pistol belt, trouser belt, bandoleer, or other material can be used as a swathe. The swathe should be three to six inches wide.

FIGURE 12-14. SWATHES

Place one end of the swathe at the breast pocket nearest the uninjured arm.

Wrap the swathe across the sling (if used), around the upper arm on the injured side, behind the casualty's back, under the uninjured arm, and back to the breast pocket.

Tie the two ends in a nonslip knot.

When possible, apply two swathes.

When swathes are used to immobilize a splinted arm without a sling, a swathe is applied above the fracture site and another swathe is applied below the fracture site.