FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 132

Lossoffunctionoftheinjuredextremityisnotareliablesignofafractureandcanbean
emotional response to an injury. A few injuries are so painful that function is lost without
fracture. Function may persist even thoughafracture is present, particularly with compres-
sion fractures of vertebrae and fractures of small bones in the feet and hands.
In a wilderness situation, ascertaining that a fracture is present is not essential. If a frac-
ture is suspected, its existence should be assumed until X-rays prove otherwise. Occasions
commonly arise, particularly with ankle injuries, in which an extremity is severely injured
but does not appear to be fractured. In a remote area, delaying evacuation until the charac-
teroftheinjurybecomesevidentmaybedesirable.Ifafractureispresentbuttheextremity
has been immobilized and elevated, the delay would rarely have an adverse effect on heal-
ing. If no fracture is present, the person may be able to walk out.
TREATMENT
Immobilization
The basic treatment for any fracture is immobilization, which minimizes further tissue
damage by the bone ends, reduces pain, and decreases shock. Permanent immobilization
by a cast or surgically implanted hardware allows the fracture to heal.
Immobilizing a fracture in a wilderness setting can be challenging if splints must be
improvised. Any material that stabilizes the fracture can be used. A folded newspaper,
magazine, or map is particularly effective for splinting fractures of the forearm and wrist.
(Cardboard arm and leg splints are used in alpine ski areas.) Ensolite pads may be used to
splint forearms or lower legs, and they make excellent cylindrical splints for knee injuries.
Crosscountry skis or ice axes can be used for lower-leg splints. Pillows, heavy clothing, or
sleeping bags can be used to splint ankles. Metal pack frames can be used for splints, and
the pack straps can be used to hold the splint in place.
Bony prominences at the wrist, elbow, ankle, and knee must be padded to prevent dis-
comfortandnervedamagefromhardsplintmaterials.Theinjuredpersonmustbegiventhe
responsibility for reporting any symptoms, or any change in existing symptoms, that may
herald nerve or vascular compression.
A large and well-prepared outing probably should carry splints. Padded aluminum
splints (SAM splints®) are lightweight, relatively small, and can easily be molded to form
stable splints for fractures of the neck, arms, wrists, lower legs, or ankles.
Inflatable splints have largely been replaced by more versatile SAM Splints® and are
most suitable forimmobilizing fractures ofthe lower leg andankle. These splints are light-
weight although somewhat bulky, easy to apply, and help control hemorrhage by applying
pressure over the leg when the splint is inflated. (The air pressure in the splint may need to
be briefly lowered every one to two hours to ensure the blood supply to the skin is not im-
paired.) Inflatable splints ( Fig. 11-1 ) must be protected from puncture during evacuation.
Changes in air pressure within the splint with changes in altitude and environmental tem-