tape, clothing, or other suitable materials. If possible, one person should hold the splints in position while another person fastens them.
Although splints should be applied snugly, they should NEVER be tight enough to interfere with the circulation of the blood. When you are applying splints to an arm or a leg, try to leave the fingers or toes exposed. If the tips of the fingers or toes become blue or cold, you will know that the splints or bandages are too tight. You should examine a splinted part approximately every half hour and loosen the fastenings if the circulation appears to be impaired. Remember that any injured part is likely to swell, and splints or bandages that are applied correctly may later become too tight.
Figure 4-52.Closed and open fractures.
A break in a bone is called a FRACTURE. There are two main kinds of fractures. A CLOSED FRACTURE is one in which the injury is entirely internal; the bone is broken but there is no break in the skin. An OPEN FRACTURE is one in which there is an open wound in the tissues and the skin. Sometimes the open wound is made when a sharp end of the broken bone pushes out through the flesh; sometimes it is made by an object such as a bullet that penetrates from the outside. Figure 4-52 shows closed (A) and open (B) fractures.
Open fractures are more serious than closed fractures. They usually involve extensive damage to the tissues and are quite likely to become infected. Closed fractures are sometimes turned into open fractures by rough or careless handling of the victim.
It is not always easy to recognize a fracture. All fractures, whether closed or open, are likely to cause severe pain and shock; but the other symptoms may vary considerably. A broken bone sometimes causes the injured part to be deformed or to assume an unnatural position. Pain, discoloration, and swelling may be localized at the fracture site, and there may be a wobbly movement if the bone is broken clear through. It may be difficult or impossible for the victim to move the injured part; if able to move it, there may be a grating sensation (crepitus) as the ends of the broken bone rub against each other. However, if a bone is cracked rather than broken through, the victim may be able to move the injured part without much difficulty. An open fracture is easy to recognize if an end of the broken bone protrudes through the flesh. If the bone does not protrude, however, you might see the external wound but fail to recognize the broken bone.
1. If there is any possibility that a fracture has been sustained, treat the injury as a fracture until an x-ray can be made.
2. Get the victim to a definitive care facility at the first possible opportunity. All fractures require medical treatment.
3. Do not move the victim until the injured part has been immobilized by splinting unless the move is necessary to save life or to prevent further injury.
4. Treat for shock.
5. Do not attempt to locate a fracture by grating the ends of the bone together.
6. Do not attempt to set a broken bone, unless a medical officer will not be available for many days.
7. When a long bone in the arm or leg is fractured, the limb should be carefully straightened so that splints can be applied unless it appears that further damage will be