If the fracture is open, stop the bleeding and treat the wound before attempting to treat the fracture. NOTE THAT TREATMENT OF THE FRACTURE DEPENDS PARTLY UPON THE LOCATION OF THE BREAK.
If the fracture is in the upper part of the arm near the shoulder, place a pad or folded towel in the armpit, bandage the arm securely to the body, and support the forearm in a narrow sling.
If the fracture is in the middle of the upper arm, you can use one well padded splint on the outside of the arm. The splint should extend from the shoulder to the elbow. Fasten the splinted arm firmly to the body and support the forearm in a narrow sling, as shown in figure 4-54.
Another way of treating a fracture in the mid- dle of the upper arm is to fasten two wide splints or four narrow one about the arm and support the forearm in a narrow sling.
Figure 4-54.Splint and sling for a fractured upper arm.
If you use a splint between the arm and the body, be very careful that it does not extend too far up into the arm- pit; a splint in this position can cause a dangerous compression of the blood vessels and nerves and may be extremely painful to the victim. If the fracture is at or near the elbow, the arm may be either bent or straight. No matter in what position you find the arm, DO NOT ATTEMPT TO STRAIGHTEN IT OR MOVE IT IN ANY WAY. Splint the arm as carefully as possible in the position in which you find it. This will pre- vent further nerve and blood vessel damage. The only exception to this is if there is no pulse distal to the fracture, in which case gentle traction is applied and then the arm is splinted. Treat the victim for shock and get him or her under the care of a medical officer as soon as possible.
The femur is the long bone of the upper part of the leg between the kneecap and the pelvis. When the femur is fractured through, any attempt to move the limb results in a spasm of the muscles and causes excruciating pain. The leg has a wob- bly motion, and there is complete loss of control below the fracture. The limb usually assumes an unnatural position, with the toes pointing out- ward. By actual measurement, the fractured leg is shorter than the uninjured one because of con- traction of the powerful thigh muscles. Serious damage to blood vessels and nerves often results from a fracture of the femur and shock is likely to be severe.
If the fracture is open, stop the bleeding and treat the wound before attempting to treat the fracture itself. Serious bleeding is a special danger in this type of injury, since the broken bone may tear or cut the large artery in the thigh.
Carefully straighten the leg. Apply two splints, one on the outside of the injured leg and one on the inside. The outside splint should reach from the armpit to the foot. The inside splint should reach from the crotch to the foot. The splints should be fastened in five places: (1) around the ankle; (2) over the knee; (3) just below the hip; (4) around the pelvis; and (5) just below the arm- pit (fig. 4-55). The legs can then be tied together to support the injured leg as firmly as possible.
It is essential that a fractured thigh be splinted before the victim is moved. Manufactured splints, such as the Hare or the Thomas half-ring trac- tion splints are best, but improvised splints may be used. Figure 4-55 shows how boards may be used as an emergency splint for a fractured thigh. Remember, DO NOT MOVE THE VICTIM UN- TIL THE INJURED LEG HAS BEEN IM- MOBILIZED. Treat the victim for shock, and evacuate at the earliest possible opportunity.
When both bones of the lower leg are broken, the usual signs of fracture are likely to be present. When only one bone is broken, the other one acts as a splint and, to some extent, prevents defor- mity of the leg. However, tenderness, swelling, and pain at the point of fracture are almost always