Posted on Posted in Extremities


Outside the typical scrapes, bruises, and cuts; bone and joint injuries are the most common to occur while in the wilderness. I remember when I was 14 years old, I tripped and fell while on a hike in the Catskills. As I fell I put my hand out and snapped my wrist. After splinting my arm, I had to hike out about three miles to the car. I broke my wrist, spent the rest of the summer in a cast and was back on the trail a week latter.

This story illustrates that a fall in the wild may have some serious medical issues associated with it. That is an in jury like I described could have some compilations that are associated with it. Infection, loss of mobility, and loss of the limb are all possibilities.

Evacuation vs. Not

As the medically trained individual with your group you need to take into consideration the need to evacuate the injured person. Is this going to be a hike out, call for rescue, call for helicopter, or can you continue your outing and monitor the victim.

All of these considerations need to be taken as you treat the victim and discuss the best treatment plan with your group. Now considering the Method Of Injury (MOI) this maybe an easy question to answer as far as the treatment goes. However if the MOI is not known such as a twisted ankle a few miles back and the victim cannot put his boots back on, now that takes a little more planning.

So after your initial assessment and you find no other injuries with the injured joint or bone then the ongoing assessment you need to take the following considerations. Treat all injuries as if they are broken. That is unless you have a portable X-ray with you, you will not know if it is a fracture or just a simple sprain,  splint to current guidelines, and do no further harm.


There are basically two types of fractures: open and closed. With an open (or compound) fracture, the bone protrudes through the skin and complicates the actual fracture with an open wound. After setting the fracture, treat the wound as any other open wound.The closed fracture has no open wounds. Follow the guideline for immobilization, and set and splint the fracture.

The signs and symptoms of a fracture are pain, tenderness, discoloration, swelling deformity, loss of function, and grating (a sound or feeling that occurs when broken bone ends rub together).

The dangers with a fracture are the severing or the compression of a nerve or blood vessel at the site of fracture. For this reason minimum manipulation should be done, and only very cautiously. If you notice the area below the break becoming numb, swollen, cool to the touch, or turning pale, and the victim shows signs of shock, a major vessel may have been severed. You must control this internal bleeding. Rest the victim for shock, and replace lost fluids.

Traction without a Traction Splint is not recommended in the wilderness, however if this needs to be done for medical care of the victim I will give you a few examples of how to do this. Also it is never recommended to treat an open fracture with traction. This is because you will do more damage to the victim than help. Remember the first action of EMS is to do not further harm (yes I repeated that.)

Often you must maintain traction during the splinting and healing process. You can effectively pull smaller bones such as the arm or lower leg by hand. You can create traction by wedging a hand or foot in the V-notch of a tree and pushing against the tree with the other extremity. You can then splint the break.

Very strong muscles hold a broken thighbone (femur) in place making it difficult to maintain traction during healing. You can make an improvised traction splint using natural material as follows:

Get two forked branches or saplings at least 5 centimeters in diameter. Measure one from the patient’s armpit to 20 to 30 centimeters past his unbroken leg. Measure the other from the groin to 20 to 30 centimeters past the unbroken leg. Ensure that both extend an equal distance beyond the end of the leg.

Pad the two splints. Notch the ends without forks and lash a 20- to 30-centimeter cross member made from a 5-centimeter diameter branch between them.

Using available material (vines, cloth, rawhide), tie the splint around the upper portion of the body and down the length of the broken leg. Follow the splinting guidelines.

With available material, fashion a wrap that will extend around the ankle, with the two free ends tied to the cross member.

Place a 10- by 2.5-centimeter stick in the middle of the free ends of the ankle wrap between the cross member and the foot. Now using a stick twist the material to make the traction easier

Continue twisting until the broken leg is as long as or slightly longer than the unbroken leg.

Lash the stick to maintain traction.

Note: Over time you may lose traction because the material weakened. Check the traction periodically. If you must change or repair the splint, maintain the traction manually for a short time.


Dislocations are the separations of bone joints causing the bones to go out of proper alignment. These misalignments can be extremely painful and can cause an impairment of nerve or circulatory function below the area affected. You must place these joints back into alignment as quickly as possible.

Signs and symptoms of dislocations are joint pain, tenderness, swelling, discoloration, limited range of motion, and deformity of the joint. You treat dislocations by reduction, immobilization, and rehabilitation.

Reduction of the dislocation in the field is not recommended, however if access to definitive care is going to be delayed for a long period of time, you may want to consider reduction.

Reduction or “setting” is placing the bones back into their proper alignment. You can use several methods, but manual traction or the use of weights to pull the bones is the safest and easiest. Once performed, reduction decreases the victim’s pain and allows for normal function and circulation. Without an X-ray, you can judge proper alignment by the look and feel of the joint and by comparing it to the joint on the opposite side.

Immobilization is nothing more than splinting the dislocation after reduction. You can use any field-expedient material for a splint or you can splint an extremity to the body. The basic guidelines for splinting are:

  1. Splint above and below the fracture site.
  2. Pad splints to reduce discomfort.
  3. Check circulation below the fracture after making each tie on the splint.
  4. To rehabilitate the dislocation, remove the splints after 7 to 14 days.
  5. Gradually use the injured joint until fully healed.


The accidental overstretching of a tendon or ligament causes sprains. The signs and symptoms are pain, swelling, tenderness, and discoloration (black and blue).When treating sprains, think RICE

  • Rest injured area
  • Ice for 20 minuets on and 20 minuets off for 24 hours
  • Compression wrap a stretch bandage and splint to help stabilize. Leave hiking boots on unless circulation is compromised
  • Elevation of the affected area


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