Bone and Joint

Part of First Aid

Fractures and dislocations are among the most common serious injuries in a survival scenario — mishandle them and a recoverable injury becomes a permanent disability.

The Stakes

In a world with orthopedic surgeons and X-ray machines, a broken bone is a solved problem. Without them, you are working blind, relying on physical examination and centuries of field medicine knowledge. The good news: humans have been setting bones for thousands of years before radiology existed, and the techniques work. The bad news: mistakes are permanent. A femur that heals 3 cm short means a lifelong limp. A wrist fracture that heals out of alignment means a hand that cannot grip properly. Getting this right matters.

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Anatomy You Need to Know

You do not need medical school, but you need to understand the basics:

• Long bones (femur, tibia, humerus, radius, ulna) — the structural columns of your limbs. Fractures here cause the most dramatic deformity and carry the highest risk of complications
• Joints — where bones meet. Major joints: shoulder, elbow, wrist, hip, knee, ankle. Dislocations occur when bone ends are forced out of their normal alignment
• Ligaments — connect bone to bone at joints. Sprains are torn or stretched ligaments
• Tendons — connect muscle to bone. Cannot be splinted; they need rest to heal
• Blood vessels and nerves — run alongside bones. Broken bone ends can sever these, causing bleeding and loss of sensation or movement below the injury

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Identifying Fractures vs. Sprains vs. Dislocations

Telling these apart without imaging requires careful examination.

Feature	Fracture	Sprain	Dislocation
Deformity	Often visible — limb at wrong angle, shortened, or rotated	Swelling but normal shape	Joint looks “wrong” — bone end visibly out of place
Pain location	At a specific point on the bone shaft	Around a joint	At the joint, with bone end palpable in wrong position
Crepitus (grinding)	Often present when bone ends move against each other	Absent	Absent
Movement	Abnormal motion at fracture site; motion at the joint above/below may be intact	Painful but possible at the joint	Joint is locked — cannot move through normal range
Weight bearing	Usually impossible on lower limb fractures	Painful but sometimes possible	Impossible
Swelling	Develops rapidly (minutes to hours)	Develops over hours	Immediate, with visible deformity

The Circulation Check

Every bone and joint injury requires a circulation check below the injury site. This is non-negotiable.

Check these three things distal to (below) the injury:

1. Pulse — feel for a pulse at the wrist (radial artery) for arm injuries, or at the ankle (posterior tibial artery) for leg injuries
2. Sensation — can the patient feel you touching their fingers or toes?
3. Movement — can they wiggle their fingers or toes?

If any of these are absent, the injury is compromising blood flow or nerve function. This changes the urgency from “splint and monitor” to “this limb may be lost if circulation is not restored within hours.”

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Fracture Types and What They Mean

Closed Fracture

The bone is broken but the skin is intact. This is the more common and less dangerous type. Infection risk is low. Splint, immobilize, monitor.

Open (Compound) Fracture

The bone has punctured through the skin, or the wound communicates with the fracture. This is a surgical emergency in the modern world. Without surgery, your priorities are:

1. Control bleeding with direct pressure around (not on) the bone end
2. Do NOT push the bone back under the skin — this introduces surface bacteria into the fracture site
3. Cover the exposed bone with a clean, moist dressing (saline-soaked cloth is ideal)
4. Splint the limb in the position found, protecting the wound
5. Monitor aggressively for Infection Prevention — open fractures have an extremely high infection rate

Warning

Open fractures without surgical debridement have infection rates of 30-50%. Clean the wound as thoroughly as possible, apply honey as an antiseptic, and change dressings every 12 hours. Watch for signs of gas gangrene (rapidly spreading swelling, skin crackling, foul smell) — this is almost always fatal without surgical intervention.

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Dislocations

A dislocation is a joint where the bone ends have been forced apart and are no longer in contact. The most common survival-scenario dislocations are shoulder (anterior), finger, and patella (kneecap).

General Principles

• Time matters. Muscles around a dislocated joint go into spasm quickly. The longer a joint stays dislocated, the harder it is to reduce (relocate). If you can attempt reduction within the first 30 minutes, success rates are much higher
• Never force it. Reduction should use slow, steady traction (pulling), not violent jerking. If it does not go back with steady force, stop — you may be dealing with a fracture-dislocation that requires surgical intervention
• Check circulation before AND after. A dislocated joint can compress blood vessels and nerves. Reduction usually restores circulation, but check to confirm

Shoulder Dislocation (Anterior)

The most common large-joint dislocation. The arm hangs slightly forward and outward, and the patient cannot rotate the arm inward or bring it across the chest. A hollow is visible below the point of the shoulder where the humeral head should be.

Reduction technique (Stimson method — safest for untrained providers):

1. Have the patient lie face-down on a raised surface (table, log pile, truck bed) with the injured arm hanging straight down over the edge
2. Attach a 3-5 kg weight to the wrist or have someone apply gentle downward traction on the hand
3. Wait 15-30 minutes. Muscle spasm gradually releases, and the humeral head slides back into the socket with a palpable clunk
4. If it does not reduce, gently rotate the forearm externally (outward) while maintaining traction
5. After reduction, immobilize the arm in a sling with the elbow bent to 90 degrees and the arm bound to the torso for 2-3 weeks

Finger Dislocation

Common and usually straightforward to reduce.

1. Grip the dislocated finger firmly
2. Apply steady traction (pull) along the axis of the finger
3. While pulling, gently guide the displaced bone end back into alignment
4. Buddy-tape the reduced finger to an adjacent finger for 2-3 weeks

Patella (Kneecap) Dislocation

The kneecap slides to the outside of the knee. Visually obvious — the front of the knee looks flat and the kneecap is palpable on the lateral side.

1. Slowly straighten the knee by extending the leg
2. As the knee extends, gently push the patella medially (toward the midline) back into its groove
3. Splint the knee in full extension for 3-4 weeks

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When to Attempt Realignment of a Fracture

In general, splint a fracture in the position found. However, there is one exception that overrides this rule:

If circulation is absent below the fracture (no pulse, blue or white fingers/toes, no sensation), the broken bone is compressing or kinking a major blood vessel. Without restoring blood flow, the limb will die within 4-6 hours.

Procedure:

1. Have an assistant stabilize the limb above the fracture
2. Apply slow, steady traction (pulling) along the long axis of the limb below the fracture
3. Gently realign the limb toward its natural position while maintaining traction
4. Check circulation immediately — if pulse returns, splint in the new position
5. If circulation does not improve, the vessel may be torn rather than kinked. There is nothing more you can do without surgical access

Warning

Realignment carries risks: you can sever blood vessels, damage nerves, or convert a closed fracture to an open one. Only attempt this when the alternative — losing the limb to ischemia — is worse.

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Recovery and Healing Times

Without surgical hardware, fracture healing relies entirely on the body’s natural processes. Proper immobilization and nutrition are critical.

Bone	Approximate Healing Time	Notes
Finger	3-4 weeks	Buddy tape; start gentle movement after 3 weeks
Wrist (radius)	6-8 weeks	Splint forearm wrist to elbow
Forearm	8-12 weeks	Must immobilize both radius and ulna
Humerus (upper arm)	6-10 weeks	Sling and body binding
Collarbone	6-8 weeks	Sling; heals well without surgery
Rib	4-6 weeks	No splinting possible; rest and pain management
Femur (thigh)	12-16 weeks	Traction splint required; see Traction Splint
Tibia (shin)	10-16 weeks	Long leg splint
Ankle	8-12 weeks	Splint in neutral position (90 degrees)

Adequate protein intake accelerates bone healing. If available, bone broth made from animal bones provides calcium, phosphorus, and collagen — the building blocks of bone repair.

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Key Takeaways

• Always check circulation (pulse, sensation, movement) below any bone or joint injury — compromised blood flow is a limb-threatening emergency
• Open fractures carry a 30-50% infection rate without surgical debridement; clean aggressively and monitor obsessively
• Dislocations should be reduced as quickly as possible — muscle spasm makes reduction progressively harder after 30 minutes
• Only attempt fracture realignment when circulation below the break is absent; otherwise, splint in the position found
• Healing times without surgical hardware are measured in weeks to months — plan for the patient to be out of action for extended periods