FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 155

Treatment consists of immobilization and applying cold and a pressure bandage for
twenty-four hours following injury. After twenty-four hours, local heat should be applied,
and activity can be allowed to the limits of pain tolerance. However, if a fracture or dislo-
cation cannot be ruled out, immobilization should be continued.
Sprains and Strains
Sprains and strains are stretching, tearing, or avulsing injuries of ligaments around a
joint and often cannot be differentiated from fractures without X-rays. They can be as dis-
ablingasabrokenbone.Thesignsaresimilartoafracture,althoughgratingofbrokenbone
ends and deformity are not present. Swelling is often quite marked, and discoloration may
also be present. If an injury is obviously severe, the wisest course is to treat it as a fracture.
The treatment for sprains is summarized in the acronym RICE, which stands for Rest,
Ice, Compression, and Elevation. An elastic bandage can partially immobilize a small joint
such as an ankle and provides compression that helps limit swelling. Applying cold imme-
diately after an injury reduces hemorrhage and swelling. Absorption of blood and edema
fluid can be promoted by elevating the injured area. Later, heat may be helpful but should
not be applied until at least three days after the injury. Motion and use may speed recovery
but only when resumed after the initial swelling and hemorrhage have subsided.
Sprainedanklesarethemostcommoninjuriesofthistype,andcircumstancesfrequently
require the individual to walk (hobble) from the injury site. In most situations a figure-
eight bandage over the shoe or boot should support the ankle. Loops of the figure eight
should pass around the back of the heel and under the sole of the foot, crossing on top of
the foot. Support must be snug but must not obstruct the circulation. The injured person
can no longer rely on the injured ankle, and the risk of further damage is significant.
Iftheankleistobetaped,thefootshouldbeheldperpendiculartothelegwhilethetape
is applied. Alternate interlacing layers of tape should be placed under the heel and straight
up the leg, and around the back of the heel and straight out over the foot ( Fig. 11-17 ) . Tape
must not completely surround the leg, or swelling (which could result just from immobil-
ization) would impair blood circulation to the foot. The ankle should be taped only for the
first three or four days of use after healing is underway.
One of the most common downhill skiing injuries is a strain or tear of the ligaments of
the knee. Occasionally the cartilage that covers the joint surfaces also is injured. The knee
should be splinted as if it were fractured, but the person may be able to walk after the knee
hasbeenimmobilized.Ifstandingorwalkingispainful,theindividualshouldbeevacuated
bysledorstretcher.Suchinjuriesfrequentlyrequireacastandfourtosixweeksormoreto
heal.