d. Remove Jewelry, If Appropriate. If the casualty has a suspected fracture of
the arm, remove any jewelry on the injured arm and put the jewelry in the casualty's
pocket. If the limb swells, the jewelry may interfere with blood circulation. The jewelry
may then have to be cut off to restore adequate blood circulation.
e. Assess Distal Neurovascular Function. Check for impairment of the
nerves and/or circulatory system below the site of the suspected fracture. Some of the
methods used to identify impairment are given below.
(1) Check pulse. Palpate a pulse site below the fracture site. If no pulse or
a weak pulse is found, the fracture may be putting pressure on the artery or may have
damaged the artery. A weak pulse can be determined by comparing the pulse felt
below the fracture with the pulse felt at the same location on the uninjured limb. A
casualty with no pulse below the fracture site should be evacuated as soon as the limb
(2) Check capillary refill. If the fractured limb is an arm, press on the
casualty's fingernail, then release. If normal color does not return within two seconds,
the limb may have impaired circulation. This is also called the blanch test.
(3) Check skin temperature. Touch the casualty's skin below the fracture.
Coolness may indicate decreased or inadequate circulation. Compare the temperature
of the injured limb to the temperature of the same area on the uninjured limb.
(4) Check sensation. Ask a conscious casualty if he can feel your touch.
Then lightly touch an area below the fracture. For example, if his arm is fractured, touch
the tip of the index and little fingers on the injured arm. Ask the casualty if the injured
limb feels numb or has a tingling sensation.
(5) Check motor function. Ask a conscious casualty to try opening and
closing the hand of an injured arm or moving the foot of an injured leg. If the attempt
produces pain, have the casualty stop his efforts.
f. Dress Wounds. If the fracture is open, apply a field dressing or improvised
dressing the wound before splinting the limb. Do not attempt to push exposed bone
back beneath the skin. If the bone slips back spontaneously, make a notation of the
fact on the casualty's U.S. Field Medical Card (FMC). The card is initiated after
treatment is completed and accompanies the casualty to the medical treatment facility.
g. Immobilize Fracture. Immobilize the fracture to relieve pain and to prevent
additional damage to tissues at the fracture site due to movement of the fractured
bone(s). If an extremity is fractured, apply a splint using the following general rules.
The general principle is "splint the fracture as it lies." Do not reposition
the fracture limb unless it is severely angulated and it is necessary to
straighten the limb so it can be incorporated into the splint. If needed,
straighten the limb with a gentle pull.
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