Fractures: How to Recognize and What to Do
Fractures are divided into two types: open and closed. The main difference is the presence of a wound.
• Open Fracture: The bone has broken the skin and is protruding, or the wound is deep and a bone fragment is visible. This is very dangerous due to the risk of infection.
• Closed Fracture: The skin is not broken, and the bone is inside. It's harder to identify, but you can suspect it based on severe pain, swelling, and the unnatural position of the limb.
Important Rule: If you're unsure whether it's a fracture or a severe sprain/dislocation, always follow the "fracture" protocol. It's better to be safe than sorry.
General Procedure:
1. Calm the person down and have them lie down.
2. The main goal is to immobilize the injured body part. This prevents bone fragments from shifting, increasing pain, or damaging surrounding tissues. Splints, bandages, and makeshift materials are used for this.
3. For an open fracture, first clean the skin around the wound with an antiseptic (if available) and apply a clean (sterile) dressing to cover the wound and protect it from dirt. Do not touch or try to push the bone back in! After this, you can proceed to apply a splint
4. Call for rescuers or arrange for transportation to a hospital.
How to Make a Splint from Makeshift Materials
An ideal splint is a straight, sturdy object that can be tied to the limb to create immobility. In the mountains, perfect materials include: a straight, strong branch, a thin log, a board, a trekking pole, or even a bundle of thick twigs tied together.
The main rule for application: First, wrap the victim's limb with soft material, clothing, or moss (anywhere the splint will touch the skin), and only then apply and tie the splint. This protects the skin from pressure and chafing.
Arm Fractures (Humerus or Forearm)
1. First, the arm needs to be supported to take the weight off. The best way is to make a sling (cravat bandage).
- How to make it: Take a large, triangular piece of fabric (for example, tear a sheet or use a large scarf). If the fabric is rectangular, fold it diagonally in half.
- How to apply: Place one end of the fabric over the shoulder of the uninjured arm. The triangle should hang down in front of the chest. Gently place the injured arm, bent at the elbow, into the resulting "pocket" (hand slightly higher than the elbow). Bring the other end of the fabric up to the opposite shoulder and tie both ends together on the side or at the back of the neck, ensuring it doesn't press on the spine.
2. For additional stabilization, tie the supported arm to the torso with a wide bandage or belt, passing it over the sling and around the chest.
3. For a severe (comminuted) fracture or if you suspect bone displacement, it's better to apply a splint.
- For a humerus fracture: You'll need two splints. They must be long enough to cover both joints: the shoulder (above) and the elbow (below). Apply the splints to the outer and inner sides of the arm.
- For a forearm fracture: The splints should immobilize the elbow and wrist joints.
- Securing: Tie the splints to the arm at three points: around the fracture site itself (not too tight), and above and below it — near the joints.
Leg Fractures
This is a serious injury. The splint needs to be applied to almost the entire leg.
1. For a fracture of the lower leg or thigh, find a long splint (stick, board). It should start at the foot and end above the knee, or better yet, reach the armpit, especially if the femur is broken. Apply the splint to the outside of the leg (alongside the body) and carefully tie it with bandages, ropes, or strips of fabric at several points: to the foot, the lower leg, the thigh, and to the torso above the hip.
2. Fracture of the kneecap (patella):
- Do not try to straighten the leg by force! Find the position of the knee that causes the least pain (usually it is slightly bent).
- Gently wrap the knee in cloth.
- Make a pad from a jacket or sleeping bag and place it under the knee so the leg rests on it without sinking.
- Immobilize the leg with splints from mid-thigh to mid-calf, or simply tie the injured leg to the healthy one (if you can't make a splint).
Rib Fractures
1. Main symptom: It hurts to breathe. If a broken rib has pierced the lung, the victim may cough up frothy, bright red blood.
2. First aid aims to restrict the movement of the ribcage.
3. Method 1: Use the victim's arm on the injured side as a splint. Bend the arm at the elbow and press it against the chest, securing it with a sling (as for an arm fracture). This will limit movement on that side of the chest during breathing.
4. Method 2: Lay the victim down. Firmly, but not too tightly (to avoid restricting breathing), wrap the chest with a wide bandage or strip of fabric. Tie the knot on the uninjured side or on the stomach. A soft pad can be placed under the bandage over the fracture area.
5. Important: If the chest is crushed (there is an indentation), do NOT apply a tight bandage!
Nose Fracture
1. Signs: Change in the shape of the nose, bleeding.
2. First aid: Seat the victim, ask them to breathe through their mouth and tilt their head slightly forward (not back, to prevent blood from flowing down the throat). Pinch the nose just below the bridge with your fingers (thumb and index finger) for 10 minutes. Breathe through the mouth. Then slowly release. If bleeding continues, pinch again for 10 minutes. Apply a clean cloth to any skin lacerations.
Jaw Fracture
1. Signs: The jaws don't align properly, it's painful to talk or swallow, gums may bleed.
2. First aid: Apply cold (snow in a bag, cloth soaked in ice-cold water) to the fracture site — this will reduce pain and swelling. The jaw can be stabilized with a bandage only if it doesn't interfere with breathing or cause vomiting. The main goal is to get the person to a hospital as quickly as possible, as these injuries are often accompanied by concussions
Collarbone (Clavicle) Fracture
1. Signs: The person instinctively holds the elbow on the injured side against their body and supports it with their other hand, leaning toward the injured side.
2. Applying a bandage: Your task is to secure this position.
- Make one sling (triangular bandage) to support the arm.
- Fold a second triangular bandage lengthwise several times to make a wide strap. Use this strap to firmly (but not too tightly!) tie the held arm, along with the forearm, to the chest. This will immobilize the collarbone.
Fracture of Fingers or Toes
1. Important: If there are rings on the fingers — remove them immediately, before the finger swells!
2. Foot/toe fracture: Remove shoes and socks (you may need to cut the boot if the foot is severely swollen). Elevate the leg by placing a backpack under it and secure it in this position. Apply cold, wrapped in cloth.
3. Finger fracture: Immobilize the entire arm in an elevated position (support it in a sling). The broken finger itself can be carefully bandaged to the adjacent healthy finger, placing a small piece of soft cloth between them.
Dislocations: What You Need to Know
A dislocation occurs when the bone surfaces within a joint are forced out of their normal positions (the joint "pops out"). The symptoms are very similar to a closed fracture: sharp pain, swelling, inability to move the joint.
The main rule for dislocations is the same as for fractures: DO NOT TRY TO POP IT BACK IN! A doctor must do this, as you could tear ligaments or blood vessels.
First aid for a dislocation (the ankle is most commonly affected):
1. Rest: Strictly forbid the victim from putting any weight on the leg.
2. Cold: Apply ice (or a bag of snow/cold water) wrapped in cloth to the joint. If no ice is available, constantly wet a cloth with ice-cold water from a stream and reapply it.
3. Immobilization: Apply a tight (compression) bandage around the joint to restrict its movement. The bandage should cover the area below and above the injured joint (e.g., for an ankle dislocation, wrap from mid-foot to mid-calf).
4. Elevation: Elevate the injured leg by placing a pad of clothing under it. This helps reduce swelling.
5. Footwear: If the ankle is injured, you don't necessarily have to remove the boot (it can act as a splint), but be sure to loosen the laces to prevent constriction if swelling occurs. If the boot is too tight and causing problems, remove it.
Next guide: First Aid on a Hike: Burns, Overheating, and Hypothermia Previous guide: First Aid for Wounds on a Hike: A Survival Guide You can view the full list here: Survival Guides for the Mountains
