An open or compound fracture occurs when a broken bone segment punctures the skin, creating an open wound. This injury is severe because it allows bacteria to contaminate the bone and surrounding tissues, significantly increasing the risk of deep infection. Immediate professional medical attention is mandatory. The first action upon recognizing this injury must be to contact emergency medical services (911 or your local equivalent). Any first aid administered prior to the arrival of paramedics is solely for temporary stabilization and preventing further damage.
Initial Response and Addressing the Wound
The immediate priority after calling for help is ensuring the safety of both the injured person and the rescuer before any direct care is provided. Once the scene is safe, the rescuer should quickly assess the injured person’s responsiveness, airway, breathing, and circulation (A-B-C checks), addressing any life-threatening issues first. The open fracture requires immediate attention to prevent excessive blood loss and limit environmental contamination.
Controlling severe bleeding is the subsequent step, and this must be done with caution to avoid pushing the exposed bone or contaminating the wound further. Apply steady, direct pressure to the area around the wound using a sterile dressing or the cleanest material available, such as a clean cloth or a piece of clothing. Never attempt to push a protruding bone back beneath the skin, as this action drives contaminants deeper and can cause additional soft tissue damage.
The wound must be covered to protect it from further environmental exposure until medical personnel can perform definitive cleaning. Cover the entire open fracture site with a sterile or very clean dressing, securing it gently with a bandage. The goal is to create a temporary barrier against contamination, not to clean the wound or remove embedded debris. Removing constricting items like jewelry from the injured limb is also important before swelling begins, as this can quickly compromise circulation.
Essential Materials and Splinting Principles
The purpose of applying a splint is to immobilize the fractured limb in the position it was found, which minimizes movement of the broken bone ends. Immobilization is crucial because any subsequent movement can tear blood vessels, nerves, or muscles, leading to increased pain and permanent tissue damage. A splint should only be applied if professional medical help is delayed and the injured person needs to be moved or stabilized for a prolonged period.
Improvised splint materials should be rigid yet accessible, such as rolled newspapers, thick magazines, wooden boards, sticks, or firm cardboard. Securing materials can include strips of cloth, triangular bandages, belts, or duct tape. The splint must be well-padded to prevent the rigid material from creating pressure points that could constrict circulation or cause skin injury.
A fundamental principle is to splint the limb in the position it was discovered, never attempting to straighten or realign the bone fragments. A properly applied splint must extend beyond the joints immediately above and below the fracture site. For example, a forearm fracture requires the splint to immobilize both the wrist and the elbow joints to ensure full stabilization.
Step-by-Step Stabilization Procedure
Once the wound is covered and materials are gathered, the physical stabilization process begins. The limb must be supported manually in the position it was found throughout the entire application to prevent movement of the fracture fragments. If the limb is severely angled and circulation is compromised, a slight, gentle pull along the long axis may be attempted to improve alignment, but this should only be done if absolutely necessary and without force.
Ample padding must be positioned between the skin and the rigid supports. This padding, such as strips of cloth or soft towels, should be placed along the entire length of the splint to distribute pressure evenly and prevent injury from the hard splint material. For a limb fracture, a minimum of two rigid splinting materials should be placed parallel to the limb, one on each side, extending well past the joints above and below the break.
Secure the rigid splints to the padded limb using securing materials, starting from the point farthest from the injury and moving inward. The securing ties must be snug enough to hold the splint firmly but not so tight as to impede blood flow. Place ties immediately above and below the fracture site, as well as near the ends of the splint, but never directly over the open wound or protruding bone.
Knots should be tied on the side away from the injury to avoid placing direct pressure on the fracture site. Check the securing materials multiple times during application to ensure they are not overtightened, which is a common cause of neurovascular compromise after splinting. After the splint is fully secured, encourage the injured person to keep the limb completely still while awaiting medical personnel.
Monitoring Circulation and Preparing for Transport
Immediately following splint application, a thorough check of the limb’s neurovascular status below the injury site is mandatory. This check confirms that the splinting process has not inadvertently cut off blood flow or compressed nerves. Circulatory status can be assessed by examining the color and temperature of the skin, such as the fingertips or toes, which should remain pink and warm, similar to the uninjured limb.
The capillary refill test is a simple assessment, performed by gently pressing on a fingernail or toenail until it blanches, then releasing the pressure. In a person with adequate circulation, the color should return to the nail bed within two seconds; a longer delay suggests restricted blood flow. Ask the injured person if they experience numbness, tingling, or a pins-and-needles sensation, which are all signs of nerve or vascular compression.
If any signs of compromised circulation are noted (e.g., pale or blue skin, coolness, or numbness), the securing ties must be immediately loosened until normal color and sensation return. The limb should be elevated slightly if possible to help reduce swelling, provided this does not cause additional pain or movement at the fracture site. Treat the injured person for potential shock by keeping them warm and reassured while continually monitoring their condition until the emergency medical team assumes care.