Page 97 - JSOM Fall 2023

these semi-custom units would have limited availability and apparatus surrounding the individual’s ankle, these supports
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durability in an austere environment. Future work on prefab- may provide self- contained traction to the affected limb. Such
ricated splints for in-field fractures could leverage some design improvised traction splinting techniques have been shown to
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features from femur fracture (usually traction-type) splints to be equally effective as commercially available devices. Im-
enhance mobility. For example, transferring loads around the provised traction splinting may also incorporate the litter to
fracture site to the pelvis (usually to the ischium) while pro- provide the rigid structure for traction application or be made
viding longitudinal structural rigidity to the limb may enable from a crutch, albeit neither of these options would enable
weight-bearing through the device and promote ambulation. independent mobility. 46,47 The potential need for PCC by both
Other limitations of prefabricated splints include long appli- military and civilian personnel highlights the importance of
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cation times as well as potential loss of traction over time. examining alternative options to prefabricated braces and
Novel designs that address these pitfalls will likely be more techniques.
complicated than what has been traditionally used for in-field
fracture care. Thus, innovators should make every effort pos- Traction may be contraindicated in circumstances that some-
sible to specifically define the goals and requirements of each times occur alongside fractures, such as compartment syn-
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new design to produce the most effective product possible. drome. In these scenarios, a simple improvised splint (e.g.,
box splint) can be applied to immobilize the fracture. Impro-
vised splints, particularly when applied to fractures below the
Improvised Splinting Techniques
knee, should immobilize the joint above and below the frac-
Improvised splinting techniques offer advantages for austere ture (usually the knee and the ankle) non-circumferentially to
environments and during PCC scenarios when commercial allow for swelling. 20,22,45,48 These splints can be made from the
immobilization options may not be available (Figure 4). Brac- same structural resources as previously described for traction
ing an extremity in these resource-constrained environments splints (e.g., closed-cell foam pads and ski poles), yet without
may require the use of materials found in Soldiers’ or hikers’ the capability of pulling the limb distally. In an austere envi-
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packs or in the local environment. For example, the impro- ronment, other materials can be used as substitutes for items,
visation of a splint using the Soldier’s rifle was used until the such as the large closed-cell foam pads common to wilderness
issue of shorter rifles (~1911), after which the ‘rifle splint’ packs. For example, personnel in combat units routinely have
was replaced with wooden sticks and utilized other materi- access to hydration bladders capable of holding 70-oz of water
als available to the medical provider. 41,42 During World War that, when filled, can be used to stabilize an extremity frac-
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I, these improvised splinting systems were superseded by the ture. A civilian case report documented the successful use of
Thomas splint once its availability improved. 43,44 In addition, an inflated hydration bladder in conjunction with a rigid item
closed-cell foam pads, common in backcountry scenarios, can from the environment (e.g., a stick) to supply additional struc-
be employed to provide structural integrity around a frac- tural support along the long bones of the forearm, a design
tured limb, while traction can be applied by creating an an- reminiscent of commercial air splints. Not only does this im-
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kle hitch that utilizes fabric (e.g., webbing) to circumvent the provised hydration bladder splint immobilize the fracture site,
ankle joint and pull the extremity distally (Figure 4). 20,22,45 To the inflated bladder may apply modifiable pressure that can
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augment stability and further minimize interfragmentary mo- optimize hemorrhage control. In fact, the International Com-
tion, rigid supply items such as ski poles, tent poles, or pieces mission for Mountain Emergency Medicine recommends the
of wood can be placed along the long axis of the limb, ei- use of a compression splint/pressure dressing for traumatic in-
ther unilaterally or bilaterally. When secured to the traction juries that involve hemodynamic instability. Multiple inflated
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FIGURE 4. Improvised splint – This improvised traction splint is made up of a closed-cell foam trail chair, knife sheath, tent poles as rigid
support, a hydration pack for proximal padding and support, and straps from a pack to secure the improvised splint to the affected limb.

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