FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 133

perature must be anticipated. Heavier splints with zipper closures and screw-type air locks
seem to work better than lighter, self-sealing splints, which are affected by large temperat-
ure changes.
To achieve immobilization, both the joint above and the joint below a fracture must be
splinted. For a fracture of the forearm, the wrist and elbow should be immobilized. For a
fracture of the lower leg, the knee and ankle must be stabilized.
Fractures of the thigh (femur) are often associated with severe bleeding and usually are
very painful, particularly a few hours after injury when the surrounding muscles go into
spasm. Immobilization of such fractures, particularly during evacuation, requires traction,
which is described in more detail in the specific discussion of such injuries.
To apply a splint or to pack the individual in a basket stretcher, a fractured extremity
must be straightened, which can be accomplished most readily with traction immediately
after the fracture has occurred. Straightening also improves the stability of the extremity.
Later, muscle spasm and the individual's diminished tolerance for pain make manipulation
more painful and more difficult but still worth doing.
A definite indication for manipulation of a fractured limb is loss of the blood supply
to the limb beyond the fracture site. If the ends of fractured bones obstruct blood flow by
pressing on an artery, or have lacerated the artery, the result is severe pain, numbness, and
coldness in the affected limb, which typically is cyanotic or pale. If the bone ends are only
pressing against the artery or vein, restoration to normal position may relieve the obstruc-
tion. If the vessel is actually torn, manipulation is usually not helpful. (Loss of sensation
may also result from injury to a nerve.)
Figure 11-1. Inflatable splint for fractures of the lower leg and ankle
Bleeding
Some bleeding occurs with all fractures. Broken bones with sharp ends can cause ex-
tensive destruction of the surrounding soft tissues and profuse blood loss. Fractures of the
pelvis or thighs are usually associated with severe bleeding. The hemorrhage often causes
shock and can be lethal, and yet may produce little or no external evidence of bleeding.
Anyone caring for an injured person with either of these injuries—or multiple fractures of
other bones—must be aware of the threat of shock and should institute treatment in anti-
cipation of its appearance.
Open Fractures