Carefully straighten the injured limb. Immobilize the fracture by placing a padded board under the injured limb. The board should be at least 4 inches wide and should reach from the buttock to the heel. Place extra padding under the knee and just above the heel, as shown in figure 4-38. Use strips of bandage to fasten the leg to the board in four places: (1) just below the knee; (2) just above the knee; (3) at the ankle; and (4) at the thigh. Do not cover the knee itself. Swelling is likely to occur very rapidly, and any bandage or tie fastened over the knee would quickly become too tight. Treat the victim for shock and evacuate as soon as possible.

Clavicle Fracture
A person with a fractured clavicle usually shows definite symptoms. When the victim stands, the injured shoulder is lower than the uninjured one. The victim is usually unable to raise the arm above the level of the shoulder and may attempt to support the injured shoulder by holding the elbow of that side in the other hand. This is the characteristic position of a person with a broken clavicle. Since the clavicle lies immediately under the skin, you may be able to detect the point of fracture by the deformity and localized pain and tenderness.

If the fracture is open, stop the flow of blood and treat the wound before attempting to treat the fracture. Then apply a sling and swathe splint as described below (and illustrated in figure 4-39).

Bend the victim's arm on the injured side, and place the forearm across the chest. The palm of the hand should be turned in, with the thumb pointed up. The hand should be raised about 4 inches above the level of the elbow. Support the forearm in this position by means of a wide sling. A wide roller bandage (or any wide strip of cloth) may be used to secure the victim's arm to the body (see figure 4-35). A figure-eight bandage may also be used for a fractured clavicle. Treat the victim for shock and evacuate to a definitive care facility as soon as possible.

Figure 4-37.-Splint for a fractured femur.

Figure 4-38.-Immobilization of a fractured patella.

Rib Fracture
If a rib is broken, make the victim comfortable and quiet so that the greatest danger the possibility of further damage to the lungs, heart, or chest wall by the broken ends is minimized.

The common finding in all victims with fractured ribs is pain localized at the site of the fracture. By asking the patient to point out the exact area of the pain, you can often determine the location of the injury. There may or may not be a rib deformity, chest wall contusion, or laceration of the area. Deep breathing, coughing, or movement is usually painful. The patient generally wishes to remain still and may often lean toward the injured side, with a hand over the fractured area to immobilize the chest and to ease the pain.

Ordinarily, rib fractures are not bound, strapped, or taped if the victim is reasonably comfortable. However, they may be splinted by the use of external support. If the patient is considerably more comfortable with the chest immobilized, the best method is to use a swathe (fig. 4-40) in which the arm on the injured side is strapped to the chest to limit motion. Place the arm on the injured side against the chest, with the palm flat, thumb up, and the forearm raised to a 45 angle. Immobilize the chest, using wide strips of bandage to secure the arm to the chest.

Do not use wide strips of adhesive plaster applied directly to the skin of the chest for immobilization since the adhesive tends to limit the ability of the chest to expand (interfering with proper breathing). Treat the victim for shock and evacuate as soon as possible.

Nose Fracture
Afracture of the nose usually causes localized pain and swelling, a noticeable deformity of the nose, and extensive nosebleed.

Stop the nosebleed. Have the victim sit quietly, with the head tipped slightly backward. Tell the victim to breathe through the mouth and not to blow the nose. If the bleeding does not stop within a few minutes, apply a cold compress or an ice bag over the nose. Treat the victim for shock. Ensure the victim receives a medical officer's attention as soon as possible. Permanent deformity of the nose may result if the fracture is not treated promptly.