When not to set a broken bone | The Survival Doctorby James Hubbard, MD, MPH

It’s getting hot out there, so let’s cool off a little: It’s winter. You’re at your homestead, miles from the city. A severe ice storm has frozen your area. Large branches have crashed from the weight of the ice. The road is impassible, and there’s no phone service.

You venture outside, just a bit, to survey the damage. Wouldn’t you know it; you slip backward. Your outstretched arm braces your fall. Immediate, intense pain. To your horror, your forearm is now crooked.

You know you won’t be able to get professional help for at least another 24 hours. The pain is excruciating.

So, should you have a family member try to put this displaced fracture back in place?

Sometimes, in the excitement of an injury, your instinct is to do something—anything—to try to fix it. But before you do any medical procedure like this, first stop and ask yourself: How is the procedure is going to help? And is it worth the risk?

In this situation, setting the bone is probably not a good idea, unless there’s nerve or circulation damage. Here’s why.

Note: This post is about closed fractures; in other words, the bone has not pierced through the skin. For open fractures, setting the bone carries even more serious risks.

When not to set a broken bone | The Survival Doctor

Muscles pull displaced fractures tight. Usually, the broken pieces end up overlapping each other. This is one reason traction (a method of pulling on the bone) is the proper way to set a bone, rather than simply bending it back straight.

Setting a Broken Bone Is Risky

Setting a bone (putting it back into place) can hurt, really bad. And even if you know what you’re doing, you can do more harm than good. You can damage muscle, tendons, ligaments and nerves.

So in general, the best thing you can do is ensure the bone doesn’t move any more, at all:

  1. Initially, don’t use the arm, which shouldn’t be much of a problem since it usually hurts like the dickens if you try.
  2. Then splint.
  3. A sling can help keep the bone immobilized.
  4. If the break is to a leg or foot, keep most or all of your weight off it because putting weight on it can make the bone move also.

>> Next step: Use RICES.

But Every Once in a While, Setting a Bone Is a Good Idea

Reasons to consider putting a broken bone back into place are:

  1. You suspect it’s cutting off circulation (you can’t feel a distal pulse), or
  2. It has damaged a nerve (there’s numbness or weakness in the fingers or toes).

Even then, just splinting is usually fine if you’re going to get expert help within a few hours.

If, perchance, you’re going to be unable to get to a doctor for many days, the only way I’d ever try to set a bone is traction. When you see a crooked bone, your instinct may be to pull down on the crooked part and straighten it out as if it were a new joint. That’s a never-do. It can cause even more damage than proper traction. Sometimes traction doesn’t work. Even then, do not move the bone around.

And the one time traction many be lifesaving is with a femur (thighbone) fracture. That’s because the very large artery sitting next to the femur can get injured. If the flesh is not cut, allowing you to apply direct pressure to the source of bleeding, applying traction to the leg by pulling on the foot can help. Click here for more on that.

Long-Term Reasons for Setting a Bone

A bone can heal crooked. So setting a long bone in an adult isn’t for healing so much as for function and cosmetic reasons.

Sometimes, even if a bone is professionally set, it won’t heal; it’ll just stay broken. The pain doesn’t continue, but it may be weaker or not function as well. A surgeon could put a bone graft in there to make it heal.

Children Need Different Treatment

Since kids’ bones are still growing, the treatment is different. Many a crooked bone is molded out, with time, with no help other than to keep it splinted. On the other hand, if a break disrupts the growth plate (metaphysis) located near the ends of the bone, if that is not set perfectly straight, there can be some serious growth distortion in the bone. All the more reason to have it checked out and X-rayed if needed, but in the field it boils back down to all you can do is splint and wait.

 

Illustration by Community Emergency Response Team (CERT) [Public domain], via Wikimedia Commons.

X-ray courtesy Chrisnorlin at the English language Wikipedia (GFDL or CC-BY-SA-3.0), from Wikimedia Commons.