BONE AND JOINT INJURY
This is the most rudimentary forms of
first Aid and should be resorted to only if there is no
possibility of obtaining professional medical
assistance. See
legal
The more active you are the more likely that you could face bone and joint injuries that include fractures,
dislocations, and sprains.
Fractures
There are basically two types of fractures: open and closed.
With an open (or compound) fracture, the bone protrudes through
the skin and complicates the actual fracture with an open wound.
After setting the fracture, treat the wound as any other open
wound.
The closed fracture has no open wounds. Follow
the guidelines for immobilization, and set and splint the fracture.
The signs and symptoms of a fracture are pain, tenderness,
discoloration, swelling deformity, loss of function, and grating
(a sound or feeling that occurs when broken bone ends rub
together).
The dangers with a fracture are the severing or the compression
of a nerve or blood vessel at the site of fracture. For this
reason minimum manipulation should be done, and only very
cautiously. If you notice the area below the break becoming numb,
swollen, cool to the touch, or turning pale, and the victim shows
signs of shock, a major vessel may have been severed. You must
control this internal bleeding. Treat the victim for shock, and
replace lost fluids.
Often you must apply traction (pulling the bones into
alignment- often due to the pain and muscle tension the
muscle will contract and cause the bone segments to slip
past the fractures and need to be pulled back and
sometimes held) during the splinting and
healing process. You can effectively pull smaller bones such as
the arm or lower leg by hand. You can create traction by wedging a
hand or foot in the V-notch of a tree and pushing against the tree
with the other extremity. You can then splint the break.
Reduction or "setting" is placing the bones back into
their proper alignment. You can use several methods, but manual
traction or the use of weights to pull the bones are the safest
and easiest. Once performed, reduction decreases the victim's pain
and allows for normal function and circulation. Without an X ray,
you can judge proper alignment by the look and feel of the joint
and by comparing it to the joint on the opposite side.
Very strong muscles may hold a broken thighbone (femur)
out of place
making it difficult to maintain traction during healing. You can
make an improvised traction splint using natural material (See
the illustration) as follows:
Guidelines for
Immobilizing and Splinting:
Immobilization is nothing more than splinting
the fracture or a dislocation after reduction. You can use any field-expedient
material for a splint or you can splint an extremity to the body.
The basic guidelines for splinting are:
- Splint above and below the fracture site.
- Pad splints to reduce discomfort.
- Check circulation below the fracture after making each tie
on the splint.
Splinting
method:
- Get two forked branches or saplings at least 5 centimeters
in diameter. Measure one from the patient's armpit to 20 to 30
centimeters past his unbroken leg. Measure the other from the
groin to 20 to 30 centimeters past the unbroken leg. Ensure
that both extend an equal distance beyond the end of the leg.
- Pad the two splints. Notch the ends without forks and lash a
20- to 30-centimeter cross member made from a 5-centimeter
diameter branch between them.
- Using available material (vines, cloth, rawhide), tie the
splint around the upper portion of the body and down the
length of the broken leg. Follow the splinting guidelines.
- With available material, fashion a wrap that will extend
around the ankle, with the two free ends tied to the cross
member.
- Place a 10- by 2.5-centimeter stick in the middle of the
free ends of the ankle wrap between the cross member and the
foot. Using the stick, twist the material to make the traction
easier.
- Continue twisting until the broken leg is as long or
slightly longer than the unbroken leg.
- Lash the twisting stick to maintain traction.
- The ankle wrap must not cut off
circulation to the foot. Constantly
monitor for discoloration or a loss of
body temperature in the foot. Loosen to
restore circulation and devise and
alternate method for the ankle wrap.
Note: Over time you may lose traction because the material may
weaken. Check the traction periodically. If you must change or
repair the splint, maintain the traction manually for a short
time.
Dislocations
Dislocations are the separations of bone joints causing the
bones to go out of proper alignment. These misalignments can be
extremely painful and can cause an impairment of nerve or
circulatory function below the area affected. You must place these
joints back into alignment as quickly as possible.
Signs and symptoms of dislocations are joint pain, tenderness,
swelling, discoloration, limited range of motion, and deformity of
the joint. You treat dislocations by reduction, immobilization,
and rehabilitation.
To rehabilitate the dislocation, remove the splints after 7 to
14 days. Gradually use the injured joint until fully healed.
Sprains
The accidental overstretching of a tendon or ligament causes
sprains. The signs and symptoms are pain, swelling, tenderness,
and discoloration (black and blue).
When treating sprains, remember the
acronym RICE
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R
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Rest injury
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I
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Ice for 24 hours, then heat after that.
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C
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Compression-wrapping to stabilize.
Do not leave boot on,
if the foot swells you
may not get the boot off
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E
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Elevation of the affected area.
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