Autoimmobilization for fractures of the shinbone (tibia)

Authors: Simulation and Certification Center 

Editor: V.Rednenko 

Clinical situation:

• While hiking, a person fell from a height. You suspect a fracture of the right shinbone. There is no mobile connection in this location. Site of accident is save.
• Prepare the victim for transportation to the place where the ambulance can arrive by immobilizing the injured limb with makeshift items. 

Equipment for the practical skill:

• simulator;
• universal first aid kit;
• belts;
• strips of fabric (triangular bandages);
• blanket.

The procedure for performing a practical skill:

• Make sure the scene is safe.
• Introduce yourself.
• Identify the person.
• Obtain informed consent to the procedure:
  • give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure;
  • explain what you are going to do;
  • ask the patient to consent to procedure.
• Help the casualty lie down.
• Identify a type of the injury:
  • examine the person from head to toe;
  • gently steady and support the injured leg;
  • verify the injury;
  • hoose a way to immobilization.
• Call for help: ask a team member to assist you in providing first aid.
• If there is a wound, carefully expose it and treat the bleeding. Place a dressing over the wound to protect it.
• Perform immobilization:
  • o   bring the uninjured leg alongside the injured one;
  • o   slide bandages under both legs:
    • position a narrow-fold bandage at the feet and ankles (1),
    • broad-fold bandages at the knees (2) and
    • above and below the fracture site (3 and 4).
  • insert padding between the lower legs;
  • tie a figure-eight bandage around the feet and ankles;
  • secure the other bandages, knotting them on the uninjured side.
• Do not bandage over the fracture site.

•  Check the quality of immobilization.
• Ask the patient about the comfort of the body position, the presence of discomfort in the immobilized area.