Treatment of Fractures on a Hike in South Africa

Head Fractures

Very dangerous and mostly fatal. Classic signs would be bruises behind the ears or around the eyes, and fluid coming from the ears and nose. This is serious because the brain tissue would be damaged and will swell as the body tries to bring extra blood up to the brain.

Therefore never raise the patients legs as this would increase the blood flow to the brain and cause even more swelling and eventually death. Never stop the fluid from trying to escape out of the ears and nose, as this is the body’s way of trying to reduce the swelling of the brain. Try to keep the patient awake and get help ASAP.

Rib Fractures

Fractured ribs could puncture the lungs and cause difficulty and even death. The only thing you can really do is try to sit the patient up or in a comfortable position and put a jacket or blanket under his arms to “pillow splint” his ribs and make breathing easier. Also raise his legs to counteract shock.

Get help ASAP. You might have to do mouth to mouth if he stops breathing.

Pelvic Fractures

The patient can lose up to 2 – 3 Litres of blood internally, and considering that you only have about 6 Litres in the body, this is very serious and life-threatening. Other complications include a ruptured bladder, and you will find that the patient automatically urinates when the patient has fallen, on impact.

The only thing you could really do to make him comfortable is to put a blanket or something under his knees, as this takes the weight and pressure off the pelvic bones. Do not allow the patient to urinate as a full bladder (if he has one and it is still intact) will act as an internal splint and keeps the pelvic bones together.

If he does urinate, the pelvic bones have more space to move and can cause more damage.

Arm Fractures

Three things to always remember with broken bones is:

a) they can severe or squash nerves and cause paralysis.

b) they can severe or squash blood vessels(arteries) and cause death of tissue resulting in amputation in hospital.

c) bones make blood in their marrow, and when broken, blood will leak out of the bone and therefore cause internal bleeding.

Use the body’s torso as a splint. Let the patient hold his arm against him and make sure he elevates the forearm. You can take the bottom the his jersey or jacket and fold it over his arm to keep the arm against his body. Or you can use a triangular bandage and make a sling for the arm.

Please do not forget to check for a pulse in his wrist and to test for sensation by scratching his palm. If you have no pulse, please get help ASAP.

And perhaps you could try to ever so slightly pull traction on the arm to try and free the artery, although this is not really suggested as it could cause more damage and of cause is very painful. No win situation there.

Leg Fractures

The same 3 points as above apply. Check for a foot pulse and sensation on top of the foot. Never scratch underneath the foot as this might tickle the patient and cause more damage as the patient pulls his leg back.

Try to find three fairly sturdy straight branches and splint the leg by putting one splint underneath the leg for support and the other two on the inside and outside of the leg. Tie the splints together with cloth or triangular bandages at all 4 joints of the leg, i.e. at the top, above and below the knee and at the ankle.

Always use branches that are the full length of the leg irrespective of where the fracture is. If you can only find one branch, put it underneath the fractured leg and then tie both legs together. Always raise the legs once splinted as this will slow down bleeding and treat for shock. If you see that a bone is protruding, never try to push it back, just make a ring bandage and put it around the bone, then bandage the wound.

Don’t forget to recheck for a foot pulse once you have splinted, in case you have tied the bandages too tight and inhibited blood flow. If you have no foot pulse, once again try to pull slight traction on the leg to free the trapped artery. Also remember that when you are splinting a leg, you should try to support it by putting one hand under the ankle and the other under the knee, and if you have someone else with you, they should put the triangular bandages underneath the leg at the 4 joints before you put the branches under the leg.