Improvised Splinting and Traction for Fractures

In standard first aid, suspected fractures are immobilised and the person is transported to hospital. In the field — remote locations, disaster scenarios, or delayed evacuation — that simple plan may not be immediately achievable. Field splinting and, for femur (thigh) fractures, improvised traction splinting, are techniques that reduce pain, limit further damage, and make evacuation safer.

Splinting is within the capability of anyone who understands the principles. Traction splinting is more specific and applies only to femur fractures. Both should be done correctly or not at all — a badly applied splint can be worse than no splint.

Why Splinting Matters

An unstable fracture causes:

Problem	Consequence
Bone ends moving against each other	Extreme pain; additional tissue damage
Bone ends lacerating blood vessels	Internal bleeding — significant in femur fractures
Bone ends damaging nerves	Neurological deficit
Difficulty transporting the person	Movement causes further injury

A splint immobilises the fracture, reducing all of the above. It does not treat the fracture — it stabilises it until definitive treatment.

When Not to Splint — Urgent Priorities First

Do not attempt to splint until:

1. Bleeding is controlled — severe external bleeding from near the fracture site must be controlled first
2. Airway and breathing are confirmed — fracture splinting is not a priority over life threats
3. Circulation to the limb is assessed — check for pulse, sensation, and movement in the hand/foot below the fracture before and after splinting

If there is no pulse in the hand or foot below the fracture before splinting, this is a vascular injury requiring emergency surgical intervention. Do not delay calling 999 to splint.

Basic Splinting Principles

Regardless of the material used, a splint must:

1. Immobilise the joint above and below the fracture — a forearm fracture requires the wrist and elbow to be immobilised; a lower leg fracture requires the ankle and knee
2. Be padded between the splint and the skin — bare wood or metal on skin causes pressure injuries
3. Not be too tight — check circulation (pulse, skin colour, sensation) after applying; can swell as oedema develops
4. Not force the limb into an unnatural position — splint in the position found; do not attempt to straighten angulated fractures unless trained

Improvised Splint Materials

Material	Suitability
Rolled cardboard	Excellent for forearm and wrist; moulds to shape; widely available
Wooden sticks / branches	Good rigid support; pad well
Walking poles / tent poles	Good length for leg splints
Folded newspaper or magazine	Reasonable for wrist and hand; not for weight-bearing limbs
Sleeping mat (foam)	Flexible, easily shaped; can be rolled around the limb
Umbrella or broom handle	Good for longer limb segments
The person's own body	Fractured leg can be splinted to the uninjured leg; injured arm can be slung to the body

Padding materials: Clothing, sleeping bag sections, foam, folded fabric.

Binding materials: Bandages, strips of clothing, shoelaces, climbing webbing — anything that can be tied firmly without cutting into skin.

Step-by-Step — Arm Fracture Splinting

For a suspected fracture of the forearm, wrist, or hand:

1. Assess — check sensation and pulse at the hand/fingers before starting.
2. Prepare the splint — cut or fold to fit from the palm to just above the elbow; pad with clothing.
3. Position the arm — bent at approximately 90 degrees at the elbow; palm facing inward toward the body.
4. Apply the splint to the underside of the arm — palm side for forearm.
5. Secure with bandaging — start at the wrist, work upward; firm but not tight; two fingers should be able to slide under the bandage.
6. Sling — support the arm with a triangular bandage or improvised sling (scarf, belt) from the neck.
7. Recheck sensation and pulse at the fingers.

Step-by-Step — Leg Fracture Splinting

For a suspected fracture of the lower leg (tibia or fibula):

1. Assess — check pulse at the foot and sensation in the toes.
2. Prepare two splints — padded, long enough to reach from above the knee to below the ankle.
3. Apply one on each side of the lower leg (medial and lateral).
4. Secure with 4–5 binding points — above the knee, below the knee, above the fracture, below the fracture, and at the ankle; avoid binding directly over the fracture.
5. Recheck circulation at the foot.

Traction Splinting for Femur Fractures

The femur (thigh bone) is the largest bone in the body. A femur shaft fracture can cause:

• 500ml to 2 litres of internal blood loss into the thigh
• The muscle spasm that accompanies femur fractures contracts the thigh, pulling bone ends against each other, increasing pain and bleeding
• Shock from blood loss

Traction splinting counters the muscle spasm by applying gentle longitudinal traction — pulling the foot away from the body — which lengthens the thigh, reduces the muscle spasm, and reduces bleeding and pain.

⚠️ Traction splinting is only appropriate for mid-shaft femur fractures — it is contraindicated for fractures near the hip (neck of femur), near the knee, open fractures, or where there is vascular compromise. Do not apply traction if unsure of the fracture location.

Improvised Traction Splint

Commercial traction splints (Sager, Kendrick, Thomas) are carried by paramedics. An improvised equivalent can be constructed from hiking poles or straight branches:

1. One rigid pole — 15–20cm longer than the leg; lashed from the hip to beyond the foot.
2. Ankle hitch — wrap a firm bandage around the ankle and foot to provide a traction point.
3. Apply traction — a second person pulls gently on the ankle hitch while the splint is secured at the hip; traction is maintained as the splint is secured.
4. Secure the limb to the splint — bind at thigh, above and below the fracture, and just above the ankle.
5. Traction force — approximately 4.5kg (10 pounds) for an adult; aim to lengthen the thigh to match the uninjured side; enough to reduce pain.

Monitor: Pulse and sensation in the foot; watch for increasing pallor of the foot which indicates vascular compromise.

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Quick Reference

Fracture	Splint Joints	Key Check
Forearm / wrist	Elbow and wrist	Pulse + sensation at fingers
Lower leg	Knee and ankle	Pulse + sensation at toes
Femur (mid-shaft)	Hip to beyond knee	Consider traction; pulse at foot
All splints	Check after application	Circulation not compromised
Too tight signs	Numbness, tingling, pale/blue below	Loosen immediately
Do not attempt	Angulated fracture correction	Splint as found
Do not delay	999 call for any fracture with no distal pulse	Vascular emergency