FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 139

SAM Splint®, would be ideal. Straightening may be necessary before a displaced or dis-
located fractured ankle can be splinted, and that can best be achieved by applying gentle
traction on both the heel and front part of the foot while rotating the foot and ankle into a
more normal position.
Straightening should be attempted without delay to relieve pressure and stretching of
skinandofnervesandbloodvesselsthatpassthroughtheankle.Straighteningadislocated
ankle is usually easy, since the only way to dislocate an ankle is to tear the ligaments that
hold it in place. Ankle dislocations are almost always associated with fractures.
A person with a minor injury, such as a fracture of the bony protuberance on the outside
oftheankle(lateralmalleolus)orafractureoftheboneinthefootjustbelowthemalleolus
(fifth metatarsal), may be able to walk a considerable distance with a walking aid, such as
an ice ax, after immobilization. Individuals with more severe injuries may be able to hop
short distances on the uninjured leg, but evacuation for distances greater than a few hun-
dred yards usually requires a stretcher or crutches.
Leg and Knee
Fractures ofthelowerlegareusuallyobviousifthetibia (thelargerbone)orbothbones
are broken. Fractures of the fibula (the small bone on the outer side of the leg) may not be
so apparent. The diagnosis may be made by tenderness to palpation over the fibula. Most
individuals with a fibula fracture can walk gingerly on their injured leg.
Lowerlegfracturesshouldbeimmobilizedinthesamemannerasfracturesoftheankle,
with a splint on either side of the leg or with an inflatable splint. Fractures that involve the
knee require immobilization of the ankle and knee.
Kneecap
Fractures of the kneecap (patella) may be difficult to distinguish from a severe bruise.
Occasionallythefractureseversthetendonsthatextendtheknee.Toimmobilizesuchfrac-
tures, a splint that extends from the ankle to the hip should be applied. A cylindrical splint
isbest,butifmaterial tomakeoneisnotavailable, SAMSplints®placedmedialandlater-
al to the knee work well. With the knee well splinted, the injured individual should be able
to walk.
Thigh
Fractures of the thigh (femur) are usually readily apparent because they are associated
with pain and deformity. Adequate immobilization of a fracture of the femur requires trac-
tion, which should be applied as soon as possible and continued until evacuation has been
accomplished.
Immobilization is needed to control bleeding. The strong thigh muscles cause the bone
ends to override and damage the surrounding tissues, resulting in severe hemorrhage.