Splinting is genuinely teachable, unlike setting a fracture, and it is worth knowing well. Done properly it controls pain, prevents a closed fracture becoming an open one, and protects the blood vessels and nerves running past the break.
Its purpose is to hold things still until someone who can fix it takes over. Where nobody is coming, it becomes the whole of the treatment, and this page is honest about what that means.
What splinting is for
Not to fix the bone. To stop the broken ends moving, because moving ends are what cause the real damage:
- Pain, which is severe and largely caused by movement.
- Further soft tissue injury from sharp bone ends.
- Turning a closed fracture into an open one, which is a dramatically worse injury.
- Damage to the artery and nerve that usually run right past the bone.
- Bleeding. A femoral fracture can lose a litre or more into the thigh.
Immobilise it and all of those slow down.
Recognising a probable fracture
You cannot diagnose a fracture without an X-ray, and you do not need to. Treat it as one if any of these are present:
- Deformity, an unnatural angle, or a limb that looks wrong.
- A snap heard or felt at the time.
- Severe pain, especially at one specific point on the bone.
- Inability to bear weight or use the limb.
- Swelling and bruising appearing quickly.
- Grating when it moves. Do not test for this deliberately.
- The mechanism: a fall from height, a heavy impact, a twist with a load.
If in doubt, splint it. Splinting a sprain costs the person some inconvenience. Not splinting a fracture costs a great deal more.
Before you touch it
This is the most important habit on the page. A splint applied too tightly, or applied around a limb that then swells, cuts off the blood supply, and the limb can be lost. The check is what catches it, and swelling continues for hours, so one check is not enough.
Write down what you found and when. Under stress nobody remembers whether the toes were this colour twenty minutes ago.
Applying the splint
- Deal with anything more urgent first. Bleeding, breathing, responsiveness. A fracture is rarely the priority injury even when it is the most obvious one.
- Expose the injury if you can do so without moving it, by cutting clothing rather than pulling it off.
- Check CSM.
- Support the limb with your hands, above and below the injury, and keep supporting it throughout. Have a second person do this if there is one.
- Pad generously, especially over bony points and inside the splint. Clothing, towels, foam, moss, bubble wrap.
- Splint in the position you found it. Do not straighten. Do not reposition. Do not push a deformity back.
- The splint must immobilise the joint above and the joint below the break. A forearm splint that stops at the wrist has not immobilised the forearm.
- Secure above and below the injury, never directly over it.
- Firm, not tight. You should get a finger under the bindings.
- Recheck CSM immediately. If anything has worsened, loosen it and check again.
- Elevate if you can and apply cold over the padding, not directly on skin.
- Recheck every few minutes, then regularly for hours.
Improvised splints: rolled newspaper or magazine, a length of wood, cardboard, a walking pole, a rolled camping mat, a garden cane bundle. The uninjured leg makes a good splint for the injured one, strapped together with padding between. The chest does the same for an arm, with a sling and a broad bandage around the body.
A sling is the right immobilisation for most arm, collarbone and shoulder injuries and is often all that is needed.
The one exception to never straightening
Open fractures
Bone visible, or a wound over a fracture. Far more serious, because infection can reach the bone, and bone infection is very difficult to treat even with antibiotics.
- Do not push the bone back in.
- Do not clean or probe the wound, beyond removing large obvious debris sitting on the surface.
- Cover with a clean, ideally sterile, damp dressing.
- Control bleeding with pressure around the wound, not directly on protruding bone.
- Splint as normal, working around the wound.
- This is an emergency, and one of the strongest cases in the app for reaching help by any means.