Fracture Assessment and Field Splinting
In wilderness or grid-down scenarios where evacuation may be hours or days away, proper fracture management prevents secondary injury and life-threatening complications. Wilderness medicine (WFR — Wilderness First Responder — curriculum) teaches a systematic assessment: compare the injured extremity to the uninjured side, assess circulation distal to the injury (pulse, capillary refill under 2 seconds, sensation, and motor function — the CSM check). A suspected fracture should be splinted in the position of comfort. For a lower leg fracture: use two rigid materials (tent poles, trekking poles, rolled sleeping pad sections, or sturdy branches) padded with clothing and secured with strips of bandaging material, belt, or torn fabric at three points — above the knee, below the knee, and at the ankle — immobilizing the joint above and below the fracture. Traction splinting for suspected femur fracture: femur fractures can cause 1–2 liters of internal blood loss into the thigh — a life threat. A traction splint (commercial: Sager or Kendrick) or improvised version using a padded stick and a pulley-twist system applies gentle axial traction (10–15 lbs) to reduce muscle spasm, decrease internal bleeding, and relieve pain. After splinting: recheck CSM every 15–30 minutes — splints that are too tight cause nerve and vessel compression. Mark the time of splint application and document CSM findings.