Fractures

[Firedoc]

Recently my wife fell and broke her wrist. It's a type of break called a Colles Fracture.http://en.wikipedia.org/wiki/Colles%27_fracture

This type of fracture is fairly common in atheletes and in the field. Your normal response in a fall is to catch yourself. Now when I was in field med school (about 100 years ago) we were taught that on any fracture to immobilize the joint above and below the break. Also in a post SHTF situation, unless you have acess to advanced medical care, you break the cardinal rules and move the extremity into a position of function. That way even if there is a loss of some range of motion, the extremity won't be useless. Now as I said, it's been many years since my training, so if the more up to date medics disagree, please let me know.

[Fido]

In a post SHTF situation you wont have a choice but to try to reset it yourself. The most important thing to watch for beside aligning the break properly is the status of what are called the "distal nuerovascular functions".
OK what does that mean in english? Does the patient have feeling, movement, pulses and capillary refill beyond the injury, i.e. on the other side of the inury away from the heart. These functions must be checked immediately after the injury, even if it's not a post SHTF situation. Any loss of feeling or circulation after an injury is a true medical emergency. If you can get to comprehensive medical care GO! If you cant, that is the time to try to reset any fracture yourself.

[1Admin]

Excellent thread, very near and dear to my heart.

[eeyore]

Very serious thread, i have broken a few bones in my time. And wonder if badtimes come what and how i would do it. I guess if you could find medical books from the 1800's would be a good start

[thereisnospoon]

Here's a great resource

http://www.hesperian.info/assets/WTND/WTND_Full_Book.pdf

Where There is No Doctor

I have it stored on my laptop, on my thumbdrive and printed in several places. While it's not perfect, it's pretty darn good and will keep you from doing more harm than good, with a little study.

Spoon

[1Admin]

I've dealt with a couple of small extremity fractures over the last few years. While they hurt like Hades when they first happen, neither of them were ones that put me completely out of it. That's not trying to sound like a tough guy, that's just the reality of it. Mind ya we are not talking about a broken LEG though :)

On the other side of the coin, it's important to understand that most people that have even just watched some MMA type fights on TV now a days can figure out basic arm locks, etc. So the likelihood of getting a fracture in a real fight post TSHTF is probably higher than what it was 20 years ago before the UFC, Pride, etc. Heck we teach our kids class how to do arm and shoulder locks and some have even learned knee bars, etc.

I guess what I'm saying is the KNOWLEDGE on how produce fractures is out there more than ever now a days. For that reason alone we should know how to fix fractures- and of course how to avoid getting your arm broke off and put over someone's fireplace in the first place LOL ;)

[Patriotic Sheepdog]

In a true long term SHTF crisis, unless you have access to casting materials, splinting may be the only option. Trying to align prior to splinting would be helpful. If you look at pictures from long ago you can sometimes see some with "deformities" or "locked" joints. As Fido stated having distal neurovascular status intact is very important. An open fracture is a completely different ballgame. In reality the fracture area would need to be surgically debrided/cleaned and antibiotics would need to be started. In a SHTF if you don't have a means to surgically debride/cleanse, start antibiotics, clean area best you can and watch closely for infection and pray for healing.

[thereisnospoon]

From the above mentioned book Where There Is No Doctor

HOMEMADE CASTS—
FOR KEEPING BROKEN BONES IN PLACE
In Mexico several different plants such as tepeguaje (a tree of the bean family) and
solda con solda (a huge, tree-climbing arum lily) are used to make casts. However, any
plant will do if a syrup can be made from it that will dry hard and firm and will not irritate
the skin. In India, traditional bone-setters make casts using a mixture of egg whites
and herbs instead of a syrup made from plant juices. But the method is similar. Try out
different plants in your area.
For a cast using tepeguaje: Put 1 kilogram of the bark
into 5 liters of water and boil until only 2 liters are left. Strain
and boil until a thick syrup is formed. Dip strips of flannel or
clean sheet in the syrup and carefully use as follows.
Make sure the bones are in a good position (p. 98).
Do not put the cast directly against the skin.
Wrap the arm or leg in a soft cloth.
Then follow with a layer of cotton or wild kapok.
Finally, put on the wet cloth strips so that they form a
cast that is firm but not too tight.
Most doctors recommend that the cast cover
the joint above and the joint below the break, to
keep the broken bones from moving.
This would mean that, for a broken wrist, the
cast should cover almost the whole arm, like this:
Leave the finger tips uncovered so that you
can see if they keep a good color.
However, traditional bone-setters in China
and Latin America use a short cast on a simple
break of the arm saying that a little movement of
the bone-ends speeds healing. Recent scientific
studies have proven this to be true.
A temporary leg or arm splint can be made of
cardboard, folded paper, or the thick curved stem
of dried banana leaf, or palm leaf.
CAUTION: Even if the cast is not very tight when you put it on, the broken limb may
swell up later. If the person complains that the cast is too tight, or if his fingers or toes
become cold, white, or blue, take the cast off and put on a new, looser one.
Never put on a cast over a cut or a wound.

[Patriotic Sheepdog]

Many times after a break, a splint will be placed for a few days before casting. This allows any swelling to take place and start subsiding prior to placing a rigid cast. This helps in reducing the neurovascular comprimise risk that therisnospoon was refering to.

You need to remember to pad bony areas prior to placing a long term splint or cast. This will help to reduce the chance of creating a pressure sore while the splint is in place. No need to correct the fracture and create a would that can get infected and potentially cause sepsis.

[monkeybird]

In the ED we always, always used splinting material to stabilize a fracture. We splinted the extremity in the use position. i.e. the hand in the position of holding a coke can, etc. Splinting first is an absolute. The fracture is usually not placed in a cast for the first 48 hours.

Splinting material can be purchased. It's easy to use and come with a handy chart. While expensive, casting material should seriously be considered for austere medical conditions. Fractures and lacerations being the number one injury following an emergency.

http://www.amazon.com/%60Orthoplast-.../dp/B000LX1C7Q

[Rmplstlskn]

OK, educate us time for those who know...

I understand the concept of SHTF resetting of broken bones and then casting them, but I lack an understanding of how to reset bones and how do you do it with the patient awake, aware and feeling everything...

For example, if someone breaks one of the bones in their forearm, how does one know if it is a clean break and how does one "feel" the bone reset properly? I don't expect a full, multi-page step-by-step (that would be a nice addition here though), just curious how one "feels" for the right set. Does it "pop in?"

Should this patient be liquored up for pain, or locally anesthetized if one has those goodies?

Just curious...

Rmpl

[Fido]

In a Post-SHTF scenario, where you have no reasonable access to health care, you will never be able to tell if it is a "clean" break.
In reality there is no one size fits all technique to setting broken bones. The best you will be able to do is to align the bone in its natural direction using traction on the end of the extremity. And always be cognizant of your distal nuerovascular functions.
If it is a "clean" break this should work well, however if it is a comminuted fracture (shattered) it wont work so well for getting the bones back together.
the best way to guess is the mechanism of injury. If the patient was shot, expect lots of little pieces. Did they step in a hole? Could be just a simple fracture.
Anytime the bone breaks the skin though your complication rate goes through the roof.
As far as pain control, liquor them up if you can or if you do have pain meds use them. I can tell you from experience though that re-aligning a fracture oftentimes relieves a majority of the pain so you may want to wait until after the setting to decide wether to medicate your patient or not.

[Patriotic Sheepdog]

Fido had good advice. To add, depending on fracture you may not even need to re-align. If it is mildly angled, you may be able to set it quickly without pain meds. Severe angulation may need some sort of "pre-setting" pain management and . Without an x-ray and surgery, all one can hope for is close alignment good enough to make it functional after it heals.

We have spoken of "distal neuorvascular function". For those that don't know what that means, you want to make sure you have strong pulses and feeling past the break (distal). So, if your upper arm is broken, distal would be towards the hand. In the leg it would be towards the foot. Knowing where pulses are felt are important.

[Rmplstlskn]

In a Post-SHTF scenario, where you have no reasonable access to health care, you will never be able to tell if it is a "clean" break.
In reality there is no one size fits all technique to setting broken bones.

One of those "I hope I never have to deal with this in a SHTF event..." but may be all too common, especially if it is a natural disaster where things fall down on people or people fall down on things...

Too bad my brother-in-law, now an interning orthopedic surgeon, is clueless to preps and preparedness... Would be an asset to any group...

Rmpl