Immobilization for bone fractures is a set of measures for various methods of fixing bone fragments in a functionally advantageous position that prevents their pathological displacement. The timeliness and usefulness of the performed immobilization of the damaged bone segment largely determine not only the outcome of treatment, but also the life of the victim.
Properly carried out transport immobilization belongs to the category of anti-shock measures and helps to prevent the occurrence of complications: secondary tissue damage, bleeding and infectious complications.
Transport immobilization is carried out at the scene of an accident both with the use of tires from packs and improvised means; its goal is to create maximum peace and immobility of the fracture site for the period of first aid and transportation of the victim to a hospital.
Basic principles of transport immobilization:
• transport immobilization should be carried out as soon as possible after the injury
• it is necessary to ensure the immobility of the fracture site and two adjacent joints
• a splint for closed fractures is applied over clothing that serves as a soft pad
• the splint is shaped (modelling) on a healthy limb and carried out before it is applied
• give the limb a physiological position, and the splint must be fixed after application
For immobilization, tires are used, which are part of the packing for a car and a stationary traffic police post.
Efficient in use are metal tires with a foamed polymer coating, which are part of the service pack, which are easily straightened out of a pre-rolled roller and are conveniently modeled according to the shape of the limb (Fig. 22).
Rice. 22. Foam coated metal tire
In case of fractures of the humerus, this splint is modeled on an intact limb; at the same time, it should fix two joints – the shoulder and the elbow. To do this, the splint is bent at a right angle along the length of the forearm, and the other end is inserted behind the shoulder blade. A cotton-gauze roller is inserted into the armpit of the injured limb, the splint is fixed with bandages to the limb and torso. If the fracture is localized in the elbow joint, the splint should cover the shoulder and reach the wrist.
In case of fractures of the bones of the forearm, the splint is bent with a groove and applied along the outer surface of the affected limb, from the middle of the shoulder to the wrist. The elbow joint is bent at a right angle, the hand is slightly unbent and brought to the stomach. A tight roller is put into the palm, the splint is bandaged to the limb, the hand is hung on the victim’s neck with a scarf.
For hip fractures, immobilization is carried out with a splint from the armpit to the ankle. In this case, three metal tires with a foamed polymer coating are used. Two of them are interconnected and applied from the armpit to the edge of the foot with bending on the inner arch of the foot. The third splint is applied along the posterior surface from the gluteal crease to the toes. Tires are fixed with bandages. Very easy to use for fixing self-locking bandages that are part of the styling.
In the conditions of an accident, in the absence of service tires, tires are used that are made independently from improvised materials (cardboard, boards, plastic, etc.) – fig. 23-26.
Rice. Fig. 23. Fracture immobilization 24. Immobilization of a fracture of the shoulder with improvised materials of the forearm using improvised means
Rice. 25. Immobilization of a hip fracture with boards
Rice. 26. Immobilization of a fracture of the lower leg with improvised means
Transport immobilization of the upper limbs can be carried out using a medical scarf bandage (Fig. 27).
The injured limb can be bandaged to a healthy one (Fig. 28).
Fastening service splints, as well as splints from improvised materials to damaged limbs, is carried out with the help of transparent sticky tape such as “adhesive tape”, ordinary bandages, elastic self-locking bandages, rolled adhesive tape; in exceptional cases, use a belt, scarf, etc.
|Rice. 27. Fixing an injured leg to a healthy one|
Injury to the spine, especially the cervical spine, is the most common type of injury in road traffic accidents. Removal of the victim from the car and its subsequent transportation should be carried out only after immobilization of the spine using a special service device – a splint for fixing the head, cervical and thoracic spine (Fig. 29, 30).
Fig. 28 Fixing the injured leg to a healthy one
Fig. 29 Immobilization of the cervical spine with a rigid cervical splint collar
Rice. 30. Immobilization of the cervical spine with a semi-rigid cervical splint collar
The cervical spine can also be fixed with an improvised cotton-gauze bandage-tire (Fig. 31).
If it is impossible to use these devices directly in the car, these tires should be applied immediately after removing the victim from the vehicle.
|Rice. 31. Improvised bandage-collar of the cervical spine from a bandage and cotton wool|
As a service tool for carrying the victim with a fracture of the spine, a shield is used – a stretcher, cross-folding with fasteners.
In the absence of standard means of immobilization of the spine, improvised means are used (shield, plywood, boards, etc.) – fig. 32, 33.
Rice. 32. Immobilization of the spine with improvised means (principle diagram)
Rice. 33. Immobilization of the spine with improvised means (principle diagram
Victims with damaged pelvic bones are laid on a hard surface on their backs, with their hips and knees half-bent and their legs turned to the side. A roller is placed under the knees from a blanket, pillow, folded clothes
Fig.34. The position of the victim with a fracture of the pelvic bones (frog posture)