Broken bones aren’t a common injury while hiking, but accidents can and do happen. If you find yourself out in the backcountry with a fractured limb and no ER in sight you’ll need to know some basic first aid to keep from worsening the wound. A broken bone isn’t something you can fix in a pinch, but you can take a few steps to keep it from rendering you helpless in the middle of nowhere.
First, Identify the Injury
There are two primary types of broken bones: a simple or a compound fracture. If you’re unfamiliar with the differences they’re quite easy to tell apart. A simple fracture will leave your limb bruised, swollen, and possibly discolored. It might even become immobile. A compound fracture will usually pierce the skin. On the rare occurrence it doesn’t, look for signs of deformity underneath the skin. You’ll be able to feel and see the bone out of place. It generally takes quite a fall to produce a compound fracture and treating one is much more difficult.
Second, Apply Traction if Needed
Traction is essentially attempting to place the broken bone back into its normal position. With compound fractures this can be particularly painful and, in some cases, dangerous to attempt. Do not attempt to set a compound fracture unless you have medical training. To apply traction on a simple fracture, or set the break, you need to hold the proximal part of the limb, or the part closest to the center of the body. On a leg this would be the upper thigh, on an arm the part above the elbow. While holding the proximal part of the limb firmly in place, gently pull the lower limb down until it slips back into the correct anatomical position.
Truthfully, unless you’ve had practice with this step your best bet might just be to leave it in the position you find it after the break. A splint will keep it there until a doctor can assess the damage.
Third, Decide on a Splint or Tourniquet
In most cases you’ll likely skip the part where you apply traction. Most small fractures can’t be easily set in place by sight and compound fractures can bleed out when treated incorrectly. What you’ll need to do here is apply a splint or tourniquet, depending on the severity of the damage.
Simple Fracture = Splint
These can be made with materials you should have on hand. Foam sleeping pads make for excellent splints, but a few sturdy branches can do the trick in a pinch. Place the branches or pads on both sides of the leg or arm by the wound. Do not let your materials touch the wound if it’s open. Secure them around your limb with rope, cord, or even a bandana. The splint needs to be tight, but not so firm that you’re cutting off circulation to the limb.
Compound Fracture + Gushing Blood = Tourniquet
For a compound fracture, take note of the blood coming from the wound. If it’s dark and slow moving, firm pressure with gauze or a clean rag should be all you need. Just affix it to the wound with piece of your shirt and apply a splint. If the blood is bright red and coming out in spurts, you might need a tourniquet—sometimes thought of as the nuclear option. Use a piece of shirt, or if nothing else is available, rope, and place it roughly two inches above the wound toward the center of the body. The wider the material, the better.
Tie the tourniquet tightly to reduce blood flow coming out of the wound. You can place a solid branch or stick above the material and wrap the ends around it to create a dial if needed. This way you can turn it more tightly than you might be able to with you hands.
With the tourniquet in place and splint set, it’s time to get moving. Head toward the nearest exit from the trail and make your way back to civilization as quickly as possible. If you’re unable to move, or you’re with a friend who is immobilized by his wound, hopefully you have a means of connecting someone in the outside world to call for help.
Look out for signs of shock and have the wound treated by a professional as soon as possible to prevent infection.