When treating broken bones after SHTF chances are good you are not going to have access to an Orthopedic Surgeon or an X-ray machine. Some breaks are going to have to be dealt with by your highest level medic. Problem is – most medics just know how to splint. After that it is someone else’s problem. Some fractures will require an Orthopedic Surgeon and the use of power tools and shit from Home Depot.
This advice is not for modern day normal environments. It really isn’t for military settings either. If you have accesses to modern medicine don’t use this advice. Basically…don’t use this when we have rule of law. I don’t want to be sued. Proceed at your own risk.
No more RICE! For sports injuries we have been ingrained that the standard model for care is Rest Ice Compression and Elevation. I am not going into great detail but the only time RICE should be used is in preventing compartment syndrome. Click here on why RICE is now recommended…
Treating Broken Bones
Greenstick fracture is an incomplete fracture in which the bone is bent. Most often occurs in children. This is normally resolved via a cast.
Transverse fracture is a fracture at a 90 degree angle to the bone’s axis.
Oblique fracture is a fracture which the break has a slanted pattern.
Comminuted fracture is a fracture in which the bone fragments into several pieces. This is bad and not much you can do about this one either. Bullet wounds and Motor Vehicle Accidents cause this type of fracture
Impacted fracture is one whose ends are driven into each other. This is likely seen in arm fractures in children and is sometimes known as a buckle fracture.
Pathologic fracture caused by a disease that weakens the bones such as being Mr. Glass.
Stress fractures are a hairline crack. It is like when you bend a pencil or pen and it starts to crack but it hasn’t broken. You do not need to cast stress fractures. Splints and braces will do just fine.
Spiral Fractures. These are fractures where a spiral crack forms. As the name implies it is a spiral shaped fracture.
Open or Compound fractures are when the fracture is completely through the skin.
Closed Fractures are inside the skin.
You can mix and match the types of fractures.
- Signs and Symptoms.
- Swelling or Bruising.
- Abnormal Gait (walking)
- Point tenderness
- Inability to function or bear weight.
- You see freaking bones sticking out… duh.
Diagnostic Testing for Broken Bones and Fractures
A vast majority of ankle pain can be ruled out as fractures if you follow the Ottawa Ankle and Knee rules. You can rule out a knee fracture in most cases if you can say NO to the following;
- Is the Patient 55 or older?
- Is there isolated tenderness on the knee cap (patella)
- Is there isolated tenderness on the fibula head?
- Is the patient unable to bear weight?
- Is the patient unable to flex the knee to 90 degrees?
Before X Rays were available doctors used tuning forks to determine if a bone was broken. If you strike a tuning fork and have the patient hold it or place it directly on the bone in question and there is pain then it is likely the bone is broken.
If you have breaks in the following places it is a bad day.
Skull: Signs of a skull fracture are leaking Cerebral Spinal Fluid, Raccoon eyes and swelling as well as crepitus. Chances are the broke skull is the least of your worries.
Spine: When medical care is not available or is not feasible the following protocols should be considered. . Assess the mechanism of injury (MOI). If a positive or unknown MOI, protect the spine by whatever method you can. This could include (but is not limited to) manual stabilization in the in-line position. Do a thorough evaluation including a history and physical examination.
To rule out spine fractures the patient must meet all of the following:
a) Patient must be reliable. The patient must be cooperative, sober, and alert, and must be free of other distracting injuries significant enough to mask the pain and tenderness of the spine injury.
b) Patient must be free of spine pain and tenderness.
c) Patient must have normal motor/sensory function in all four extremities:
d) Finger abduction or finger or wrist extension against resistance (check both hands)
e) Foot plantar flexion/extension or great toe dorsiflexion (check both feet)
f) No complaint of numbness and sensation intact to sharp and dull stimuli in all four extremities
NOTE: If reduced function in one particular extremity can be attributed with certainty to a specific extremity injury (e.g., unstable wrist injury), that deficit alone will not stop you from ruling out a spine injury.
Pelvis: A pelvis fracture is not good. You are going to need a lot of padding and a pelvic sling. For this one you can assess this by either pressing down on the hips or inward. No need to do both. The pelvis is a big ring so you can assess a fracture easily with either method.
Femur: The femur is the largest and hardest to break bone in your body. These happen a lot in skydiving accidents and motorcycle accidents. You will know there is a femur fracture because one leg will be significantly shorter than the other and obvious deformity. Because a femur fracture can jeopardize the femoral artery it is a good idea to apply a tourniquet during transport. You are going to have to apply a traction splint. There are many available but and I do not recommend trying to improvise a traction splint. If it fails you could do additional damage.
So not only do you need to splint but you also need to pad those splints during transport of the patient. Use whatever means available. Those foam sleeping mats work best. But anything can be used.
Continue to monitor your patient for Circulation, Motor function and Sensation or CMS after you splint.
Typically in a normal setting you would NEVER try to return a open fracture back from where it came. There is a risk of further injury. However if help is long in coming the risk of infection and loss of the bone becomes so great as to overcome this risk. So you want to irrigate the bone and the wound thoroughly with the cleanest water you can. Then try to return the bone from which it came.
You have to splint above and below one joint of a suspected fracture. Using an aluminum splint is best but this can be down with rolled up newspaper, magazines, or sticks. Now the best splints for ankle and feet are an L and U shaped splint. For the knee you will need to splint three sides so that you immobilize both the side to side motion but also the back and forth motion.
Casting Broken Bones
Normally you are not going to have access to casting materials. You can improvise. Casts are just fiberglass, cotton padding and a stocking. If you do and you don’t have access to x-rays you might not be able to actually use it. If you have a simple non commuted/closed you can place a cast. Determining which fracture needs a cast without aid of x-rays is a difficult task. One most doctors will be hard pressed to make. So you will have to make pretty complex decisions on the availability of healthcare vs the environment you are in. It may be that you need to place a cast to get that person operational again…
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