FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 141

device is lighter (20 oz or 600 gm) and packs into a much smaller space than the Sager
Splint®. A makeshift traction splint can be made from two ski poles. The wrist straps can
be hooked together and slipped up against the buttock like the half ring of a manufactured
splint. A handkerchief or strap can be used to tie the hand grips together across the front of
thethighlikethebeltonastandardsplint.Bandagestiedbetweenthepolessupporttheleg,
and the hitch around the ankle is hooked to the baskets or ends of the ski poles. Other ma-
terials can be used similarly to improvise a traction splint, but improvised traction splints
almost never work as well as a manufactured splint.
Ordinary splints that do not apply traction, such as those for fractures of the ankle and
lowerleg,shouldnotbeusedforfracturesofthethighbecausetheydonotcontrolbleeding
or prevent muscle spasms. If materials to improvise a nontraction splint are available, they
can be used for a traction splint.
Individuals with a fractured thigh must be evacuated, preferably in a basket stretcher
andbymechanicalmeans,suchasahelicopter.Sincethebasketstretchermustbetranspor-
ted to the accident site, a traction splint can be transported at the same time. If avoidable,
improvised splints should not be used during evacuation.
Hip
Fractures of the hip are actually fractures of the upper portion of the femur (head, neck,
or trochanteric portion) or of the socket in the pelvis into which the head fits: the acetab-
ulum. Shortening of the leg and rotation of the foot to the outside along with pain in the
hip are the typical signs of a fractured hip. However, shortening and rotation may not be
present if the fracture is not displaced. If a fracture is suspected, the person must not be
permitted to walk on the injured leg.
Such fractures require no splinting other than binding the legs together.
SPECIFIC FRACTURES OF THE TRUNK
Pelvis
Fractures of the pelvis should be suspected following violent accidents, particularly if
side-to-side or front-to-back pressure over the pelvis causes pain. Blood loss of major pro-
portions is inevitable with pelvic fractures, is rarely evident when the person is examined,
yet commonly produces shock and may be lethal. Therapy for shock should be instituted if
a pelvic fracture is suspected.
Thesourceofbleedingisusuallythefracturesitesandextensiveveintearsinthepelvis.
Compressionandstabilizationofthepelvicfracturesmayfacilitatespontaneousbloodclot-
ting and cessation of bleeding. Although commercial compression devices are available,
these therapeutic goals can usually be achieved by wrapping the pelvis with a bedsheet or
sleeping-bag liner ( Fig. 11-6 ) . The sheet should be folded to a width that covers the en-