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Protection, and Self Defense
Basic First Aid and Street Medics
Bone and Joint Injury
You could face bone and joint injuries
that include fractures, dislocations, and sprains.
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
The closed fracture has no open
wounds. Follow the guidelines for immobilization, and set and splint the
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
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. Rest the victim for shock, and replace lost fluids.
Often you must maintain traction
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.
Very strong muscles hold a broken
thighbone (femur) in place making it difficult to maintain traction during
healing. You can make an improvised traction splint using natural material
(Figure 4-6) as follows:
- 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
- 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 stick to maintain traction. Note: Over time you may lose traction
because the material weakened. Check the traction periodically. If you
must change or repair the splint, maintain the traction manually for
a short time.
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.
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.
Immobilization is nothing more than
splinting the 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
- Pad splints to reduce discomfort.
- Check circulation below the fracture after making each tie on the splint.
To rehabilitate the dislocation,
remove the splints after 7 to 14 days. Gradually use the injured joint
until fully healed.
The accidental over-stretching of
a tendon or ligament causes sprains. The signs and symptoms are pain,
swelling, tenderness, and discoloration (black and blue).
When treating sprains, think
R - Rest injured
I - Ice for 24
hours, then heat after that.
C - Compression-wrapping
and/or splinting to help stabilize. If possible, leave the boot on a sprained
ankle unless circulation is compromised.
E - Elevation of
the affected area.