Long Bone Fractures: Radius/Ulna or Tib/Fib Fracture

• Radius / Ulna Fracture

  Resources Required:
  

  1. 1 Short Splint
  2. 5 Cravats
  3. 1 Roll of Gauze
  4. 4x4 Pads (2)

  Note: only attempt to straighten once, and only if there is no distal pulse

  • Grasp proximal and distal ends; attempt to traction once
  • Place arm into position of function [pronated]
    Ask patient to grasp a roll of gauze, or curl fingers into "grasping" position around gauze
  • Place arm on soft side of the board; board should be even with the elbow
  • Fold cravats into approximately 1 1/2-inch wide bands
  • Take PMS at extremity
  • Position first cravat over knuckles, between thumb and board
  • At bottom of board, create surgeon's knot, then another knot
  • Wrap and tie again promixal to injury site, and just distal to elbow
  • Elevate/cross arm over opposite shoulder
  • Place cravat against patient's chest, point of cravat at patient's elbow
  • Tie cravat at side of patient's neck
  • Graps end of cravat at elbow; twist so that it conforms to the elbow (creating a "pouch" for the elbow to sit in) and tuck in
  • Take a new cravat around affected shoulder/across to wrist that is on board; then tie under arm pit
  • Take PMS for extremity

  Note: for all knots, place padding between knot and patient's body

• Tib / Fib Fracture

  Resources Required:
  

  1. 4 Cravats
  2. 2 Board Splints
  3. 2 Multitrauma Dressings + 1 one more; the "crotch pad" (see below)
  4. 2 Rescuers

  • Stabilize at knee and ankle
  • Verbalize: "My partner will remove sock and shoe and perform PMS check"
  • Pass extremity to partner
  • Use three cravats
    Pass cravats behind the knee, then distribute them
    1. One cravat inferior to crotch
    2. One cravat 2" above knee
    3. One cravat 2" below knee
  • Use one board splint
    
    • Apply between patient's legs, against the leg; soft side toward patient's skin
    • Place multitrauma dressing between board and patient's body for padding
    • Cover with "crotch pad" and put board into position (snugly, not tightly)
  • Use other board at outside aspect of leg (covered with multitrauma dressing)
  • Tie cravats at crotch, above, and below knee
    Create surgeon's knots at outside of board
  • Use last cravat proximal to ankle
    Tuck ends of knots into space between leg and board
  • Take PMS at ankle

Note: as per NYS DOH requirements, candidates must fulfill the following requirements:

• Assess PMS before and after all splinting procedures
• Did not excessively move the injured extremity
• Complete the station within a 10 minute time limit.