Lower Limb Injuries

KEY POINTS

  • Fractures can be to the ankle, lower leg or thigh.
  • Splinting can provide considerable pain relief and reduce bleeding.
  • Cover open fractures with a damp dressing.

EXPLANATION

A hard landing on the legs can lead to a broken ankle, lower leg (tibia and fibula) or a broken thigh (femur). Ankle injuries commonly occur from trips on launch or a landing on uneven ground. It can be difficult to tell the difference between a severely sprained ankle and a fracture, so an x-ray is advisable in almost all cases. A femur requires a great deal more force to break, so a fracture should raise your suspicion of other serious injuries.

Broken limbs are best treated in the field by splinting. Splinting a limb means immobilising the joints or joints above and below the injury to prevent any movement of the fracture site. Some commercial splints also apply traction, a gentle but consistent pulling force on the limb that helps realign the normal anatomy. While traction is helpful in femur fractures, it is the ‘icing on the cake’. The most important thing is to achieve proper immobilisation, providing pain relief and preventing worsening of the injury.

Tips for splinting:

When shaping an improvised splint, use the other arm to mould it before applying to the injured side.

Make sure to pad any points of the splint that will apply pressure to the skin. Pressure sores develop quickly and can take a long time to heal.

Use the other leg as a support for the injured side and always tie the ankles together.

‘SAM’-style splints – flexible, lightweight, foam and aluminium splints are fantastic and can be stashed under the seat or down the back of a harness.

Before and after splinting, check that the blood and nerve supply to the limb are still intact beyond the fracture site. Signs that the blood or nerve supply might not be okay include a cold, pale, pulseless or painful limb, absent or altered sensation (e.g. pins and needles). The limb may need to be repositioned back into ‘normal’ alignment if any of these occur.