Fractures and Sprains: Field Management

Preparation Steps

Stock a splinting kit: a SAM splint or improvised rigid material (rolled newspaper, straight sticks, cardboard), elastic bandage, triangular bandage for a sling, and padding material (foam, folded clothing).
Take a first aid course that includes practical splinting and immobilization technique — reading alone is insufficient preparation for field splinting.
Learn to distinguish high-risk mechanisms (falls from height, vehicle accidents, crush injuries) that should increase your suspicion of fracture even with normal-appearing limbs.
Know where your nearest functioning hospital or clinic is and have a transport plan that does not require calling for help — plan A and plan B.
Ensure your first aid kit includes ibuprofen or naproxen for pain management and swelling reduction in musculoskeletal injuries.

For sprains, apply RICE: Rest the limb, Ice the area (20 minutes on, 20 off — never apply ice directly to skin), Compression with an elastic bandage (firm but not tight enough to cut off circulation), and Elevation above the level of the heart where possible.
For suspected fractures, immobilize the joint above and below the fracture site before moving the patient — movement of fractured bone ends causes severe pain, tissue damage, and blood loss.
Pad your splint generously before applying it — hard materials pressing directly on skin over a fracture cause additional injury.
Check circulation distal to the injury site every 15 to 30 minutes: assess capillary refill (press a fingernail, release, color should return within 2 seconds), sensation, and the ability to move fingers or toes.
Distinguish fracture from sprain where possible: suspect fracture if there is visible deformity, point tenderness directly on bone, or the mechanism was high-force — when in doubt, treat as a fracture.

Do not attempt to straighten a deformed limb unless the limb is pulseless and circulation is completely cut off — improper traction causes additional injury and should only be performed by trained providers.
Do not apply a splint or bandage so tightly that it cuts off circulation — this causes compartment syndrome, which is a surgical emergency requiring intervention within hours.
Do not move a patient with a suspected spinal injury to splint a limb — spinal protection takes priority.
Do not remove footwear from a suspected ankle fracture without first checking whether the shoe is acting as a compression device — removal can cause sudden swelling and blood loss.
Do not ignore escalating pain, numbness, pallor, or inability to move digits after splinting — these are signs of compartment syndrome requiring emergency evacuation.

SAM splint or improvised rigid materials (newspaper, cardboard, straight branches) padded with foam or folded clothing.
Elastic bandage (2-inch and 4-inch widths) for compression and splint securing.
Triangular bandage for constructing an arm sling.
Medical tape or safety pins to secure dressings and slings.
Cold pack (instant chemical pack or reusable gel pack) for acute swelling reduction.

All suspected fractures require X-ray imaging and professional medical evaluation as soon as access is available — field splinting is stabilization only, not definitive treatment.
Splinted fractures must be evaluated promptly: delayed treatment of displaced fractures significantly worsens outcomes and may require surgical correction that would not have been needed with timely care.
Monitor for compartment syndrome during transport: severe pain with passive movement of fingers or toes, numbness, pallor, and a tense, swollen limb are warning signs requiring emergency surgical evaluation.
After arrival at medical care, inform providers of the exact time of injury, the mechanism, and any changes in sensation or circulation observed since splinting.
Follow all rehabilitation and weight-bearing guidance given by medical professionals after definitive treatment — early return to activity without clearance is the most common cause of re-injury.