First Aid for Fractures While Mountain Biking

Unfortunately, broken bones (fractures) are a common phenomenon when among those gallivanting in the outdoors (please gallivant only where legal). Almost everything outside is harder and much more resistant to breaking than your bones (trees, rocks, and earth, for instance). There are two basic types of broken bones: compound and simple.

COMPOUND FRACTURES

There is a compound fracture when there is bone protruding through the skin (gross!), or when the integrity of the skin is broken over the area of a broken bone, regardless of whether you can see the bone. This doesn't apply to minor cuts or abrasions over a fracture. The only real difference between initially treating compound and simple fractures is that compound fractures can become infected much more readily.

SIMPLE FRACTURES

I'll bet you've figured this one out. Yep, simple fractures are those with no exposed bone and no large laceration over the fracture site.

PREVENTION TIP

Talk to your bones before each outing. Impress upon them the importance of not breaking.

MORE USEFUL PREVENTION TIP

Since compound fractures are, one hopes, the result of an accident and not planned, be aware of the potential for falling (or being fallen on) and take all precautions to prevent falls.

TREATMENT

So, what the heck do you do for your buddy when he breaks his leg? First, take a couple of deep breaths and try not to toss your trail mix, because the sight of a limb bending at unnatural angles or the sound of snapped bones grating on each other can be really nauseating. As always, think “A-B-C ” (A — Airway, B — Breathing, C — Circulation, then get the victim (or yourself, if alone) to a safe, warm, dry place, and arrange the injured area so that the pain is the least. Immediately after a bone is broken, the body initiates a defense response that results in massive swelling around the area. This represents eons of evolution — an attempt at an auto-splint if you will. If not otherwise apparent, this may be the main clue that a fracture exists. Next, you will need to look at both the injured area as well as the limb (assuming an extremity fracture) down toward the fingers or toes. This is because sometimes a broken bone may become displaced — no, not misplaced.

Displaced means that the broken bone fragments are no longer in a normal, straight alignment. This may cause the broken fragment to kink, block, or even cut blood vessels inside the limb.

Why is this important, you ask? I'm glad you asked. It's important because a broken bone does not normally represent a life-or even limb-threatening emergency. You may even have days to get the injured person to definitive medical help without any negative consequences. If, however, the blood vessels (arteries, here) are blocked, the person may lose the extremity after only a single hour of ischemia (no blood flow). For instance, if your partner breaks her leg and you are not able to locate a foot pulse, you have to start thinking about impaired blood flow. To compare, feel for the pulse on the other foot (or hand, if it is the arm that is broken). If you can't feel the pulse here either, then it's probably one of three things:(1) you are feeling in the wrong area — recheck the diagrams and/or ask someone else to cop a feel;(2) the person is in shock, in which case the peripheral arteries (i. e., those at the wrist and ankle) will be clamped and hard to feel; or (3) the person is cold, in which case, again, the arteries will be clamped.

If the pulse on the injured side is absent or diminished, or if the hand or foot is cold or blue in comparison with the healthy one, you need to distract, or pull apart, the broken ends and then splint the extremity in such a way that the artery will not become recompressed during transport to a hospital. You will not strengthen the bonds of a beautiful, loving relationship with your injured comrade when you do this, however. This process hurts like hell and should be done as quickly and efficiently as possible. If anyone has muscle relaxants (Valium, Flexeril, etc.) or painkillers (Demerol, ibuprofen, etc.), now would be a good time to administer them. Give the drugs 20 minutes or so to kick in and, as always, use them only as directed, do not mix medications, and make sure the victim is not allergic to the medication. Then make sure you have your splint materials ready to go.

Practice putting them on yourself so that you are not fumbling around trying to figure out the splint while your poor buddy is screaming in pain. Think about what you have at your disposal for a splint. Wrapping a sleeping pad (Ensolite or an inflatable, usually) very tightly around the extremity while someone holds the extremity in distraction works very well. In other words, pull on the injured person's hand or foot until the pulse returns, then place straight sticks, hiking poles, or such on either side of the sleeping pad, and then wrap the whole thing in duct tape. Do not wrap the duct tape (or straps, or whatever) too tightly! You don't want to place a great splint only to constrict the vessels with your wrap. Check the pulses in the affected foot or hand after you place the splint.

If splinting items are not available, then substitute what you have, but be sure you pad the extremity well. Keep in mind that you must immobilize the extremity one joint above and one below the fracture site. Otherwise the broken bones will move against each other. Using a broken lower leg as an example, you must immobilize the knee and the ankle. This will result in a straight leg: the victim will have to use a buddy as a crutch to take all the weight off the injured leg or be littered out.

If the bone is protruding or there is a large laceration over the fracture, place a clean gauze or handkerchief on the site and tape it in place before you place the splint. Do not dig around in the wound or worry too much about cleaning it. The emphasis here is splint, then transport the victim or await rescue.

There are several hundred bones in the body, so clearly we cannot cover the exact splinting mechanisms for all of them, but the concepts remain the same. Here are some special circumstances:

COLLARBONE (CLAVICLE) FRACTURE

This break usually happens when you pitch face-first while traveling on a 15% downhill grade during the final descent of an epic, heinous, way-too-technical ride. The fracture will be patently obvious because of the huge (lemon-sized) swelling where your straight-as-an-arrow collarbone used to be. Couple this with severe pain and an inability to pick your nose, and bingo! You have a diagnosis.

TREATMENT

Do not try to set or splint this fracture; it will not work, and it will cause your buddy to suffer an embarrassing bout of incontinence from the pain. Simply place the arm against the body with the elbow bent at 90 degrees and wrap the arm and body together so that the arm cannot move. Again, do not wrap too tightly.