If you broke a bone and were miles away from help, what would you do?
Let’s say you were miles from help in the backcountry on a trail where few people walk and you fell and broke your arm. Would you be able to set the bone and make a splint?
How to Set a Broken Bone
Broken bones and dislocated joints are pretty common injuries, many people might not know how to “set” a bone, or put a dislocated joint back in.
The simple answer is:
Most of the time, you should do nothing for a crooked bone or dislocated 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 where you may want to take that chance and try to set (straighten) the bone or put the joint back into place especially if you are in a situation where help is many days away.
In those cases, the key to treatment is to apply traction—properly.
How to Apply Traction Properly?
Medical traction involves pulling on a bone. So, you grab the end and pull. Easy? Well …
- 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.
- 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.
- Remember not to jerk. Begin with a slow pull, and gradually pull harder and harder and, sometimes, harder.
What Does Traction do?
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.
If there’s a fracture, splint the bone in place before you let go of the traction, to lessen the chance of the bone moving.
There are two kinds of fractures: open and closed. A broken bone projects through the skin with an open (or compound) fracture, which complicates the actual break with an open wound.
Pain, tenderness, discoloration, swelling, deformation, loss of function, and grating are all common indicators of a fractured bone, though the only way to be certain is to get an x-ray unless you have an open fracture, and that will be self-evident.
How to make a splint?
A splint consists of three parts:
- Rope to hold things in place (can use string, bandage, twine)
- Padding to protect the joint (foam, thermarest, clothes)
- Stick to immobilize the arm or leg (piece of wood or metal)
- First, you need to improvise. Be resourceful and look for any types of material that you think can work.
- Second, use two rigid pieces of material on each side of the leg (or arm), place some form of padding (if possible) to make it comfortable and tie two off both above and below the site of the fracture
- Third, Secure the splint and check for circulation to make sure it is not on too tightly
Watch the video for an arm splint demonstration.
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 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 healthcare 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 alleviate 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.
If you had to, could you set a friend’s bone if you were caught in the backcountry?
 Fractures or Dislocations Treatment. https://www.webmd.com/first-aid/fractures-or-dislocations-treatment
 Fractures (broken bones). https://www.mayoclinic.org/first-aid/first-aid-fractures/basics/art-20056641
 Orthopedic Injuries in the Wilderness. https://www.directorthocare.com/orthopedic-injuries-in-the-wilderness