Treating Broken Bones in Preppers – SAM Splint Techniques
Broken bones and apocalyptic destruction are as inseparable as preppers and bug-out-bags. So in this, our second post on fracture care (click here to review our first), we’ll be showing you everything you need to know about treating broken bones when medical help is not available.
Treating Non-Union Fractures
When a bone has been broken and its ends are still touching, it has a good chance of healing with a cast. If the broken ends are not aligned, or are not touching properly, the bone may not heal at all. This condition is called “non-union.”
Some fractures may never heal if not reset to their proper positions. Bone setting is known as “reduction” in the medical world. Open reduction is something a surgeon does through an operation. A pin or metal fixation device is inserted, bringing the ends together, and fixing the bone in place.
In the field, only closed reduction is possible. Here the bones are moved around by hand and worked back into correct alignment before the cast is applied. Doing this can be painful and challenging. It probably shouldn’t be entertained unless the broken bone has cut off the blood supply to the rest of the extremity.
Some fractures will cause this, they’ll pinch or crowd off the blood supply distal to the break. Realigning the bone by moving the broken ends close to one another, should be attempted whenever this occurs (but only if medical help is not immediately available). Most people know how to feel for a radial pulse, if it’s present after a break, you’re probably okay. If not, try to set the bone with the intention of restoring the pulse.
Treating Greenstick (Chalkstick) Fractures
Greenstick fractures occur mostly in children and young adolescents. Their bones aren’t as brittle as adult’s, and the bone’s covering is thicker. The ends remain attached with this fracture, but are often offset at an angle.
The bone covering, called periosteum, contains nerve endings and is responsible for the pain caused in fractures. Normally a physician will grasp both ends of the broken bone, and with a twist of the wrists, break the periosteal attachment so the bone doesn’t heal at an angle. This can be quite difficult to do without an X-ray and analgesia. It’s unlikely you would ever have to set a greenstick fracture, usually you’ll need an X-ray to know this type of break is present in the first place.
Regardless of the fracture type, if you don’t feel comfortable setting it, then just cast the extremity when the swelling goes down (use a splint until then.) It may heal at an angle, but at least it will heal. Recent studies have shown that greenstick fractures that are not re-broken, may heal better in a removable splint than a cast. Take a few minutes and watch some YouTube videos on splinting, and casting with plaster.
SAM Splint Application and other Splinting Techniques
Casting is tricky in the field. You probably won’t have the plaster or fiberglass needed. Pre-manufactured aircasts and pneumatic splints are available, and take up little room. They work best if the patient can remain immobile. If you do cast, remember that before applying any constrictive casting, swelling in the extremity must be allowed to resolve, otherwise the cast will fit too loosely later.
SAM Splint Techniques and Modifications
SAM Splints are some of the most versatile and space saving devices for treating orthopedic injuries. Sometimes you’ll need to immobilize two joints (remember you have to immobilize a joint above and below the fracture to ensure it heals correctly). So it makes sense to drop two into your med kit. Click the following link to learn more and / or purchase the SAM Splint kit which I and others most frequently recommend.
Applying Improvised Splints – Magazines and Newspapers
Magazines, even thick rolls of newspaper, can be used as a splint or makeshift cast. Reinforced with duct tape, they can be left on for the duration. In a psychiatric ward where I once worked, we had to cast (actually splint) patients with newspapers and tape, because they would often assault one another with their “fiber-glassed” arms. This worked well until a patient took off the newspaper and honed it into a cone, then stabbed a person in the abdomen with it. None of us saw that coming. But it’s something to keep in mind if you’re treating a person that’s a threat to themselves or someone else.
If someone in your group has had a cast before, enlist their help with the technique. They will know how it should fit and feel, having worn one for two months themselves.
If you do decide to buy casting material, purchase the old fashion plaster type. The fiberglass variety is difficult to remove, dries up in the package quickly, and is nearly impossible to remove without a special saw. Plaster casting comes apart when it gets wet, so it must be covered with plastic while bathing. But this can also work to your advantage. When the time comes to remove it, soak it instead of trying to saw it off.
Children are in a constant and dynamic state of growth. Their fractures heal quickly, about twice the rate of an older adolescent or adult. For fractures of the arm, their casts should be removed after three or four weeks, while the adolescent and adult will require six to eight weeks before healing is complete.
Treating Open Fractures
Compound or open fractures occur when a sharp bone fragment has pierced through the skin. Fortunately these don’t occur often, as they usually require a tremendous amount of force. Often the real problem is in trying to figure out if the skin above the fracture has been broken by a sharp bone fragment, or by the trauma that caused the break.
Without an X-ray it can be difficult. This is important because the natural impulse is to probe the wound to find out. Doing this is of little value. And almost guarantees the patient will get a deep infection of the bone. So keep the wound sterile, especially for the first 24-48 hours while it’s sealing over.
My recommendation would be to use a SAM splint technique, and not cast a simple open fracture (where the skin is broken but the bone is not sticking out). Try to keep the extremity immobilized. If you put a cast over it, you won’t be able to see if the wound has become infected. Also put a sterile dressing over the wound, and do not take it off any more than necessary to look at it. Studies have shown this increases the rate at which the bone gets infected. The person can become septic and die before you even know what’s happening.
To review our first post on fracture care Click Here.
The above is adapted from:
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