A snapped bone miles from help transforms a wilderness adventure into a survival situation. Proper splinting and decision-making can mean the difference between permanent disability and full recovery. Every wilderness traveler must master these critical skills.
Recognizing Fractures
Obvious Fractures:
- Visible deformity
- Bone protruding through skin
- Limb at unnatural angle
- Grinding sensation (crepitus)
- Complete loss of function
Subtle Fractures:
- Point tenderness over bone
- Rapid swelling
- Unable to bear weight
- Pain with gentle compression
- Comparing to opposite limb shows difference
When in doubt, treat as fractured
The Wilderness Splinting Golden Rules
- Splint in position found (unless circulation compromised)
- Immobilize joint above and below fracture
- Check CSM (Circulation, Sensation, Movement) before and after
- Pad all pressure points
- Reassess every 15 minutes
- Document everything
Critical Assessment: CSM Check
Before and after splinting, always assess:
Circulation:
- Check pulse below injury
- Capillary refill (press nail bed, should pink up <2 seconds)
- Skin color and temperature
- Compare to uninjured side
Sensation:
- Light touch perception
- Can they feel you touching toes/fingers?
- Numbness or tingling?
Movement:
- Wiggle fingers/toes
- Don’t test at fracture site
- Document what they can/cannot do
Loss of CSM = EMERGENCY EVACUATION
Improvised Splinting Materials
Rigid Materials:
- Trekking poles
- Branches (padded)
- Tent poles
- Ice axes
- Foam sleeping pads
- Rolled magazines/maps
- Ski poles
Padding:
- Clothing
- Sleeping bags
- Foam pads
- Moss (dry)
- Bandanas
Securing:
- Duct tape (the wilderness essential)
- Triangular bandages
- Strips of clothing
- Belts
- Pack straps
- Rope/cordage
Specific Fracture Management
Arm/Forearm Fractures
Splinting technique:
- Support fracture site
- Apply rigid splint on both sides if possible
- Secure with wraps between fracture and joints
- Sling and swathe against body
- Hand should be slightly elevated
Improvised sling:
- Triangle bandage
- Bottom of shirt pinned up
- Sleeve of jacket
- Bandana chain
Lower Leg (Tibia/Fibula)
Method 1: Sugar tong splint
- Pad from foot to upper thigh
- Place rigid support on both sides
- Figure-8 wrap at ankle
- Spiral wrap up leg
- Secure at thigh
Method 2: Anatomical splint
- Secure injured leg to uninjured leg
- Pad between legs thoroughly
- Tie at multiple points
- Works for urgent movement
Femur (Thighbone) Fractures
LIFE-THREATENING—Can lose 2 liters blood internally
Signs of shock likely:
- Pale, cool, clammy
- Rapid pulse
- Altered mental status
Traction splint (if trained):
- Apply gentle traction
- Maintain until splinted
- Secure from hip to beyond foot
- Monitor for shock
- Immediate evacuation
Without training:
- Splint in position found
- Treat for shock
- Urgent evacuation
Ankle Fractures
Common wilderness injury:
- Leave boot on (provides compression)
- Reinforce with wrap over boot
- Create U-splint with padding
- Secure thoroughly
- No weight bearing
Improvised crutches:
- Strong branches
- Trekking poles
- Ski poles
Wrist/Colles Fractures
Very common from falls:
- Remove jewelry immediately
- Splint from mid-forearm to past fingers
- Place in functional position (holding beer can)
- Secure with figure-8 wraps
- Sling for comfort
Rib Fractures
DO NOT wrap around chest (restricts breathing)
Management:
- Arm sling on injured side
- Encourage deep breathing (prevent pneumonia)
- Pain management critical
- Monitor for difficulty breathing
- Evacuate if breathing compromised
Spine Fractures
NEVER MOVE unless immediate danger
If must move:
- Maintain head/neck alignment
- Log roll with multiple people
- One person controls head
- Move as unit
- Immediate evacuation
Pelvic Fractures
HIGH MORTALITY—Internal bleeding risk
Signs:
- Pain with pelvic compression
- Unable to walk
- One leg shorter
- Foot rotated outward
Emergency care:
- Don’t move unless critical
- Improvised pelvic wrap (jacket, sleeping bag)
- Tie legs together gently
- Treat for shock
- Immediate helicopter evacuation
Open (Compound) Fractures
Bone through skin = EXTREME infection risk
- Control bleeding without pushing bone back
- Cover bone with moist, sterile dressing
- Don’t attempt to clean or reduce
- Splint carefully in position found
- Ring of gauze around protruding bone
- Antibiotics if available and trained
- Evacuate immediately
Pain Management
Non-Medication:
- Proper splinting reduces pain significantly
- Distraction techniques
- Controlled breathing
- Elevation when possible
- Ice for first 48 hours
Medication (if available):
- Ibuprofen 600-800mg
- Acetaminophen 1000mg
- Can alternate every 3 hours
- Prescription pain meds if carried
- Document all medications given
Evacuation Decisions
IMMEDIATE Evacuation (Call helicopter):
- Femur fractures
- Pelvic fractures
- Open fractures
- Spine injuries
- Loss of CSM below injury
- Signs of shock
- Multiple fractures
URGENT Evacuation (Same day):
- Any confirmed fracture
- Suspected fracture with severe pain
- Unable to continue travel
- Worsening condition
Could Continue (Rare):
- Minor finger/toe fractures
- Stable, well-splinted
- Able to travel safely
- Close to trailhead
- No CSM compromise
Special Considerations
Cold Weather:
- Frostbite risk in injured limb
- Extra insulation critical
- Check circulation more frequently
- May need to loosen splint as swelling increases
Multi-Day Evacuation:
- Re-pad pressure points daily
- Monitor for infection
- Adjust splint for swelling
- Document changes
- Keep patient hydrated
Child Fractures:
- Growth plate injuries serious
- Children compensate then crash quickly
- Evacuate all suspected fractures
- Extra padding in splints
- Calm, reassuring approach
Preventing Further Injury
During Evacuation:
- Test splint before moving
- Additional people to help carry
- Frequent rest breaks
- Monitor CSM constantly
- Have backup plan
Improvised Carries:
- Two-person carry
- Backpack carry
- Improvised stretcher
- Rope seat
- Dragging on pad/tarp
Common Mistakes to Avoid
- Moving too quickly – Take time to splint properly
- Over-tightening – Swelling will worsen circulation
- Under-padding – Pressure sores develop quickly
- Not reassessing – CSM can change
- Attempting reduction – Unless trained, don’t
- Ignoring shock – Fractures can be life-threatening
- Walking on suspected fracture – Permanent damage risk
Psychological Support
Fractures are terrifying in wilderness:
- Stay calm and confident
- Explain what you’re doing
- Involve patient in decisions
- Set realistic expectations
- Positive but honest communication
- Address fear of permanent disability
Post-Evacuation
Document for medical providers:
- Mechanism of injury
- Time of injury
- Initial CSM status
- Changes during evacuation
- Medications given
- Splinting method
Prevention
Most wilderness fractures are preventable:
- Use trekking poles
- Proper footwear
- Take breaks when tired
- Careful foot placement
- Don’t exceed abilities
- Extra caution when carrying heavy packs
The Bottom Line
Fracture management in the wilderness requires creativity, calm decision-making, and proper technique. Your improvised splint doesn’t need to be perfect—it needs to prevent further injury during evacuation. When bones break far from help, your knowledge and response determine whether your patient walks again normally or faces lifelong disability.
Practice these techniques before you need them. In the moment of crisis, you’ll default to your training.