A suspected wrist fracture requires immediate, temporary stabilization to prevent additional soft tissue and nerve damage during transport. This first aid measure involves applying a splint and securing it with a wrap solely to immobilize the injury. This process is not a definitive treatment; a fracture must be professionally evaluated by a healthcare provider. The primary goal is to hold the wrist in the position it was found, minimizing movement of bone fragments. This action helps manage pain and reduces the risk of a closed fracture becoming an open fracture.
Recognizing the Signs and Gathering Supplies
Recognizing the indicators of a wrist fracture is the first step in providing appropriate care. An injury of this type is accompanied by severe pain that increases with any attempt to move or grip an object. Visible swelling and tenderness are common, often appearing quickly after the trauma.
An obvious deformity, such as a bent or crooked appearance, is a concerning sign indicating a displaced fracture where bone fragments have shifted. Bruising may develop as blood vessels rupture beneath the skin. The patient may also report tingling or numbness in the fingers, suggesting possible nerve involvement or excessive swelling.
If a fracture is suspected, materials for temporary stabilization must be gathered quickly. Padding material is needed to protect bony prominences; soft cloths, cotton, or rolled gauze work well. Next, secure rigid splinting materials, which can include everyday items like rolled newspapers, magazines, or small, firm pieces of plastic or wood.
Finally, securing material is needed to hold the splint in place. An elastic bandage is ideal, but cloth strips, a scarf, or medical tape can also be used to immobilize the limb. Remove any rings, watches, or jewelry from the hand and wrist before swelling begins, as these items can quickly impede circulation.
Step-by-Step Wrist Stabilization
Stabilization begins with positioning the injured limb gently to avoid causing further pain. Ideally, the wrist should be immobilized in the position of function, a slightly extended, natural position. If moving the wrist causes severe pain, stabilize it in the position in which it was found. The patient can support their own wrist with their uninjured hand to maintain this position.
Once the wrist is supported, pad the area to prevent pressure sores or restricted blood flow. Padding must be placed in the palm to maintain the hand’s natural curvature, often using a rolled-up cloth or gauze in the patient’s grip. Additional padding should be placed over prominent bony areas, such as the wrist bones and the elbow, to cushion them against the rigid splinting material.
Next, apply the rigid splinting material to provide structural support. For a wrist fracture, a single piece of rigid material is typically placed underneath the forearm and wrist, extending from the elbow past the fingertips. If materials are narrower, two pieces can be used—one on the underside and one on the top—to provide better lateral support and prevent rotation.
With the splinting material in place, apply the securing wrap. The wrap should start near the fingers and move up the forearm, ensuring the fingertips remain exposed for later circulation checks. The elastic bandage or cloth strips should be wrapped firmly enough to prevent shifting, but never so tight that it restricts blood flow.
The securing wrap must extend beyond the injury site, immobilizing the joints both above and below the fracture, securing the splint across the forearm and the hand. Once secured, the entire splinted arm should be elevated above the level of the heart if possible. Elevation helps minimize swelling by assisting fluid drainage, but should only be performed if it does not increase the patient’s pain.
Monitoring Circulation and Seeking Professional Care
After the temporary splint and wrap are applied, monitoring the circulation, sensation, and movement (CSM) of the hand is essential. The most common method for checking blood flow is the capillary refill test, performed on the exposed fingernails. To perform this, press firmly on a fingernail bed until the color blanches, then release the pressure and observe the time it takes for the pink color to return.
With adequate circulation, the color should return promptly, typically within two seconds. A delayed return time suggests the wrap may be too tight, impeding blood flow. Other signs of restricted circulation include the fingers becoming cold, pale, or blue, or the patient reporting numbness, tingling, or increased pain.
If signs of compromised circulation appear, the securing wrap must be loosened immediately and reapplied more gently. Once stabilized, urgent professional medical evaluation is required, as the temporary splint is not a substitute for definitive treatment. A doctor will order X-rays to confirm the fracture, assess its severity, and determine the appropriate treatment, which may include a cast or surgery.
During transport, the patient should keep the splinted arm as still as possible, often best achieved by resting the arm in a sling or supporting it on a pillow. Even if symptoms appear mild, a suspected fracture requires timely medical attention to ensure the bone heals correctly and to prevent long-term complications like chronic pain, stiffness, or post-traumatic arthritis.