When you think of a splint, what do you picture? If you’re a trained first responder, you’ll likely think about blankets and ace bandages, maybe a traction splint. If you aren’t a first responder, your mental image of a splint probably includes a stick or two, wrapped up close to the bone that requires splinting. Every time I see a splint like this, I cringe. A few sticks and strips of cloth is not going to immobilize a fracture, which is the purpose of a splint in the first place. In order to set the record straight, I’m going to explain how to apply a splint to a broken bone. With the exception of femur fractures, the process that I am going to explain will work on the vast majority of straight bone breaks.
The injuries I will describe are a little cringeworthy, so I recommend turning back now if you have trouble stomaching the thought of a nasty injury. Consider that fair warning!
The last note, before we dive in, is a disclaimer. Unless you are qualified to perform these treatments, DO NOT try it. Call the professionals. Mistakes in the treatment of some injuries can exacerbate conditions and leave you and your good intentions facing a barrage of lawsuits. Unless you have absolutely no choice, leave it to the professionals. On to fractures!
There are several different kinds of fractures. The signs and symptoms are many and varied. The most obvious sign of a bone break is deformity in the limb, sometimes the bone will break the skin and protrude. This is called a compound fracture, which is very easy to identify. Sometimes the limb will seize up and contort, sometimes it will go all floppy. Often times there are signs of blunt trauma in the form of bruises or lacerations. Sometimes, you will be able to hear the broken bones grinding against each other in a condition called crepitus. Generally, the patient is in a lot of pain.
It hurts to break a bone! Pulling traction on the bone can alleviate pain very quickly. In a few cases, specifically when the bone shatters, it can be difficult if not impossible to traction the bone into place. If there is a marked increase in pain, or if you can clearly tell that the bone is shattered, you will not be able to traction. Stop trying, as you can cause nerve (and other) damage by trying to help. The vast majority of breaks, and the ones you are most likely to see in your lifetime, will not be this ugly. When a bone breaks, the muscles around it will spasm. The body is attempting to immobilize the injury. This is what causes the most pain to the patient. By pulling traction, you can relax the muscles and pull the bone back into its anatomically correct position.
To pull traction, get a solid grip with both hands below the fracture, and applying constant, steady pulling pressure, you can encourage the muscles to relax and the bone will realign. Don’t force it, you’ll cause more injury, just encourage the muscles to relax. It feels crazy, and is a little gut-wrenching, but it will help with the pain. When I tractioned my first bone, I pulled too hard. The patient was relieved at first, but the pain came back. I reduced the pressure, and the patient relaxed almost immediately, breathing a deep sigh of relief. When pulling traction, apply a minimum of 5 lbs of pull. Increase the pressure as you feel the muscles relax, but you will probably not pull more than 10 lbs. of pressure. It will be very apparent when the bone realigns. Sometimes there is a satisfying crunch when the bone falls into place. Oftentimes the patient will suddenly relax when their bone realigns. Sometimes there is not and obvious sign, but properly pulling traction on a broken bone with provide immediate relief from what is most likely a very painful injury.
The biggest exception to the above explanation is in the case of femur fractures. Thighs are very strong. If you pull traction on a femur and do not stabilize, the muscles are strong enough to pull the bone out of place again. This, needless to say, is excruciating, and we (as care providers) don’t want to cause any more pain than we absolutely have to. Unless you have a traction splint, or can build one, it is best to leave it to the professionals unless the situation is truly desperate.
A traction splint, in short, is designed to pull traction on the limb while also immobilizing the broken limb. they are most commonly applied to fractured femurs. It is possible to improvise a traction splint, but seek out professional instruction before you attempt it. You can also purchase traction splints that are easy to assemble and apply for treatment, but seek professional instruction before any attempts. If there is interest, i can discuss traction splints in more detail in another blog.
So, you have recognized your friends’ broken bone and pulled traction. It still hurts, but the pain is lessened. Now we can examine the patient for other injuries, and they will be in a better state of mind to answer questions. Next, we need to immobilize the injury. A good splint will keep the broken bone in place until you can get to a place where professional treatment is available. As I mentioned, splints in film and popular culture are characterized by sticks or other hard materials strapped to the limb to keep the bone in place. This doesn’t really work for a couple reasons. First of all, the pressure provided by the splint will be unevenly distributed. This can pull the bone back out of place or can be easily jostled, defeating the purpose of the splint. Second, the broken bone is likely not perfectly straight, and it will not be effectively supported by a perfectly straight stick or log. Third, rubbing an injured limb on a stiff dressing will cause pain and irritation, making it much harder for the patient to distract from the injury, and possibly causing other injuries. The exception to this rule, again, is femur breaks. A traction splint applied to a fractured femur requires a framework, as the splint needs to immobilize and pull traction at the same time. Other bones can be easily and effectively immobilized with nothing more than a blanket or extra clothing and an ace bandage.
To build a splint, get a blanket (or jacket), and an ace bandage. You’ll need a couple of triangular cravats also.
In the absence of a blanket, clothing makes a fine substitute. Lay the injured limb in front of you, fold the blanket to an acceptable length; you want to stabilize the bone, and restrict the movement of the joints below the break.
Roll the blanket (or clothing) tightly along either side of the injured limb. There should be approximately an inch of fabric covering the limb in every direction. Then simply wrap the ace bandage, tightly, around the padding from top to bottom.
Secure the ace bandage with a safety pin, or just tuck in into itself. The splint should restrict the unhealthy movement of the bone, prevent incidental movement of the fracture, and pad the injury to protect against jostling. The wrapping should not be so tight as to restrict blood flow, if the patient’s extremities tingle, unwrap the splint and wrap more loosely when you replace it.
Once the splint is applied, the patient should not use the limb: no walking on broken legs, no using broken arms. One of the best ways to keep a patient from using their broken arm is to wrap it in a sling and swath.
Building a sling and swath requires two triangular bandages, called cravats, 40″ by 40″ by 54″.
The measurement is a standard, but does not have to be exacting, use what works. Fold one of the bandages in half. These cravats are obtuse isosceles triangles, knot the two opposite corners together, and tie one more knot in the remaining corner.
Have the patient hug their injured arm to their chest, placing their hand on their heart. Loop the sling over their neck, and cradle the broken limb in the bandage. The knotted corner should be cradling the elbow, and the knot creates a nice little hammock to secure the joint.
Then take the remaining cravat and wrap it around the torso. The idea is to secure the elbow and hand to the chest, to keep the limb from being jostled. this position is not comfortable, but it limits the range of motion to virtually nothing, protecting the injury from jostling and preventing pain.
This treatment is great for limiting pain in the limb, preventing re-injury, and promoting healing. Make sure that the patient seeks proper medical care, as there are other conditions that can arise a result of bad fractures. There is no substitute for a professional.
The sling and swath is one of the most versatile and least invasive treatments out there. Simple immobilization is great for treating shoulder sprains, elbow sprains, wrist sprains; upper and lower arm fractures, rib fractures, hand fractures; shoulder dislocations; severe bruising; lacerations, etc. Being resourceful and creative is key in a first-aid situation. It’s great to master a few treatments, as you can calm the patient and make them significantly more comfortable. The splint and sling and swath are excellent tools, and can make a huge difference in a tough spot.