How to Set a Broken Bone or Treat a Dislocated Joint

The X-ray owner, Tim Snell, says this injury didn’t hurt as much as you’d think. “I can’t claim that the process of ‘popping it back in’ didn’t hurt though,” he wrote on Flickr, where he shared the X-ray. “What i thought would be a 5 second ‘click’ ended up taking 3 professionals over 10 minutes of tugging, twisting and pulling to get the little bugger back in place. it’s a good job i was pumped full of laughing gas.” (“Snap My Fingers,” shared via CC BY-ND 2.0.)

by James Hubbard, MD, MPH

Broken bones and dislocated joints are pretty common injuries, and I have several posts on how to treat them in an emergency. But many people have asked specifically how to “set” a bone, meaning, I presume, how to straighten a broken arm, leg, finger, or toe if it is crooked.

The answer is most of the time, you should do nothing for a crooked bone or displaced joint other than splint it as-is until you can get to a doctor. Trying to move it around is likely to cause more damage.

But there are some injuries when, indeed, you may want to take that chance and try to set (straighten) the bone or put the joint back into place. And, of course, there’s always a chance you’re in a situation where expert help is many days away.

In those cases, the key to treatment is to apply traction—properly.

How to Apply Traction Properly

Basically medical traction involves pulling on a bone. So, you grab the end and pull. Easy? Well …

  1. First, make sure you have a good grip because you’re going to have to pull hard and usually for several seconds, even minutes. A glove or cloth can help.
  2. Next, know that you must pull in the same directional plane as the bone. In other words, make sure you’re not angling it and putting pressure or torque on the fractured area. Otherwise you could damage the area a lot more.
  3. Remember not to jerk. Begin with a slow pull, and gradually pull harder and harder and, sometimes, harder.

>> Special traction for shoulder dislocations: Click here for how to put a shoulder back into place.

What Traction Does

With a break or dislocation, the muscles perceive the injury and contract, I guess to try to protect the bone. But this contraction and pull can also make the bone more crooked, and it will always make it harder to put the bone back into place.

With traction, we’re attempting to stretch those muscles so they give enough slack that the bone can be straightened, or so the ends of dislocated bones have enough space between them to pop back into place.

The best way to get the stretch is to start slow and kind of sneak up on the muscle, in essence letting it know you’re not there to hurt it. Then, gradually pull harder. In the end, you may have to pull really hard, but never jerk—which will only scare the muscle into contracting more.

Step 2: Splint

If there’s a fracture, have someone splint the bone in place before you let go of the traction, to lessen the chance of the bone moving.

With a dislocated joint, you can let go after it’s back in place and then splint it. In this case, the splint isn’t to keep the bones in place as much as to protect the joint. A dislocated joint is usually caused by a sudden jerk or hit that stretches or tears ligaments and tendons, which allows the bone to pop out of place. Then, very quickly, the muscles are back contracting, and the out-of-place bone is stuck but would dearly love to get back to its normal position. If you can stretch out those muscles so the end of the one bone is beyond the end of the other, it will usually gladly pop back into place and stay there. A splint allows protection and immobilization for the tendons and ligaments to heal.

When Not Do It Yourself

Any time you manipulate or move an injured part of your body you risk further injury. An experienced health care provider is less likely to cause injury and also to know when and how much straightening needs to be done. In addition, a little (or lot) of anesthesia can go a long way in allowing the muscles to relax and making it easier to put the bone back into place (not to mention alleviating the pain). So, in the great majority of the time, it’s best to splint the injury as-is and wait on an expert.

When to Consider Trying Traction

Consider trying traction for any of the following reasons:

  • To take pressure off a nerve. If the fingers or toes distal to (on the far end of) the break or dislocation are numb, there could be pressure on the nerve. In general this could wait for maybe even a day to be relieved before there’s irreversible nerve damage.
  • To take pressure off an artery. If fingers or toes distal to the break are blue or if you can’t find a pulse, taking the pressure off the artery within a few hours could save further major damage to the area not getting the blood.
  • To stop bleeding. A big, major artery lies next to femur (thighbone) and can be damaged with a break to the bone. In some cases, bleeding can be life threatening. Quite a bit of blood loss may occur even before the thigh starts swelling. Because the artery is so deep, applying direct pressure or even a tourniquet may not be enough. Applying traction may not only straighten the bone but allow the big muscles around the artery to better compress the area and decrease or stop the bleeding. This will need to be continued by then applying a traction splint. But that’s for another post.
  • Because help isn’t coming. If expert help is many days away, not getting a bone back in proper position could permanently limit the function of that bone. For instance, you’re never going to be able to move a dislocated joint. A crooked bone may be more of a judgment call. In general, if it’s not exactly straight that may be more of a long-term cosmetic issue than how it might function.

Sometimes, the only way to get perfect alignment is with surgical pins and plates—something you’d never try on your own.

Have you ever had a crooked broken bone (displaced fracture) or dislocated joint? What did you do?