Travel Reference
In-Depth Information
The danger of infection makes open or compound fractures much more serious prob-
lems.Osteomyelitis, aninfection ofbone,canproduceextensive bonedestruction andmay
prevent healing of fractures. However osteomyelitis is now uncommon due to good wound
cleansing, debridement, and antibiotics.
Anyfractureisconsideredopeniftheskinisbroken,regardlessofwhethertheskinwas
damaged by the bone ends or in some other way. A fracture produced by a penetrating in-
jury, such as a gunshot wound, is considered open because the skin is no longer able to
keep bacteria away from the injured bone.
Iftheboneendsprotrudethroughabreakintheskin,beforeanyattempttostraightenthe
extremityismade.theyshouldbecleansedwithantibacterialsoapandrinsedwithdisinfec-
tedwateruntilallvisibleforeignmaterialhasbeenremoved.Manipulationcausesthebone
ends to retract beneath the skin, and foreign material carried with them greatly increases
the severity of the subsequent infection. The wound should be left open and covered with
a bulky bandage. The individual should be evacuated as rapidly as possible. If evacuation
can be completed in a few hours, antibiotics should not be administered unless they can be
given intravenously. If evacuation must be delayed, high doses of oral or intravenous anti-
biotics should be given. A cephalosporin or amoxicillin/clavulanate (Augmentin®) are the
drugs of choice.
Control of Pain
Pain from a fracture is greatly reduced by immobilization. Shortly after injury, pain
medications are usually not needed during splinting. However, analgesics may be required
for the inevitable jolts of a prolonged evacuation over rough ground.
Ifneeded,morphinecanbeinjected intramuscularly everytwotothreehours.However,
absorption of the drug from the injection site is reduced if the person is in shock, and re-
peated injections can lead to an overdose when normal circulation is restored. Pain med-
ications usually are inadvisable for injured persons who are in shock. If such individuals
dorequireanalgesia,morphineshouldbeinjectedintravenouslyinsmallamountsuntilany
necessary manipulation has been completed or the pain has been reduced to a tolerable
level.
Transportation
Immobilization of fractures and treatment for other injuries must be completed before
the person is moved unless the injured's location is threatened by hazards such as falling
rock, an avalanche, or an electrical storm. After obvious injuries have been treated, but be-
fore evacuation is begun, the person must be slowly and thoroughly examined to ensure
thatnoadditional injurieshavebeenoverlookedintheinitial evaluation. Attentionmustbe
directed to the person's back, which is often neglected. If not treated, such injuries could
be seriously aggravated during evacuation.
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