fracture are almost always present. A fracture justabove the ankle is often mistaken for a sprain. If bothbones of the lower leg are broken, an open fracture isvery likely to result.If the fracture is open, stop the bleeding and treatthe wound. Carefully straighten the injured leg. Applya pneumatic splint if available; if not, apply threesplints, one on each side of the leg and one underneath.Be sure that the splints are well padded, particularlyunder the knee and at the bones on each side of theankle.A pillow and two side splints work very well fortreatment of a fractured lower leg. Place the pillowbeside the injured leg, then carefully lift the leg andplace it in the middle of the pillow. Bring the edges ofthe pillow around to the front of the leg and pin themtogether. Then place one splint on each side of the leg(over the pillow), and fasten them in place with stripsof bandage or adhesive tape. Treat the victim for shockand evacuate as soon as possible. When available, youmay use the Hare or Thomas half-ring traction splints.Kneecap FractureThe following first aid treatment should be givenfor a fractured kneecap (patella):Carefully straighten the injured limb. Immobilizethe fracture by placing a padded board under theinjured limb. The board should be at least 4 incheswide and should reach from the buttock to the heel.Place extra padding under the knee and just above theheel, as shown in figure 4-38. Use strips of bandage tofasten the leg to the board in four places: (1) just belowthe knee; (2) just above the knee; (3) at the ankle; and(4) at the thigh. Do not cover the knee itself. Swellingis likely to occur very rapidly, and any bandage or tiefastened over the knee would quickly become too tight.Treat the victim for shock and evacuate as soon aspossible.Clavicle FractureA person with a fractured clavicle usually showsdefinite symptoms. When the victim stands, theinjured shoulder is lower than the uninjured one. Thevictim is usually unable to raise the arm above the levelof the shoulder and may attempt to support the injuredshoulder by holding the elbow of that side in the otherhand. This is the characteristic position of a personwith a broken clavicle. Since the clavicle liesimmediately under the skin, you may be able to detectthe point of fracture by the deformity and localizedpain and tenderness.If the fracture is open, stop the flow of blood andtreat the wound before attempting to treat the fracture.Then apply a sling and swathe splint as describedbelow (and illustrated in figure 4-39).Bend the victim’s arm on the injured side, andplace the forearm across the chest. The palm of thehand should be turned in, with the thumb pointed up.The hand should be raised about 4 inches above thelevel of the elbow. Support the forearm in this positionby means of a wide sling. A wide roller bandage (orany wide strip of cloth) may be used to secure thevictim’s arm to the body (see figure 4-35). Afigure-eight bandage may also be used for a fracturedclavicle. Treat the victim for shock and evacuate to adefinitive care facility as soon as possible.4-49Figure 4-37.—Splint for a fractured femur.Figure 4-38.—Immobilization of a fractured patella.
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