Backcountry Beacon

In today’s installment of the three-part series Improvised Splints, we’ll go over how to make splints for knee, lower leg, and ankle injuries.
Check out Part I: Basic Principles of Splints if you don’t know what a cravats does, or check out Part II if you broke an arm.

Decide whether the injury is usable or unusable.

Can the injured person bear weight? Is there any way he or she will be able to walk out? If not, you’re going to have to call for search and rescue or make your own stretcher (see the note at the end of this article). If you’ve ever tried to carry someone out of the backcountry, you know it’s a royal pain in the butt and should be avoided if possible.

Usable knee injuries

A good splint for a usable knee injury limits lateral (side to side) motion of the knee but still allows for a bit of flex, which makes walking possible. A sleeping bag, pad, or even a tent fly folded over itself many times will make a good frame for a knee splint.
*TIP: Constructing a lower-extremity splint is easiest with two people. Have your helper cradle the lower leg and foot with her hand and forearm and grasp the injured person’s thigh to move the leg up and down, or have the injured person help you.

Step 1: Preparing the splint

• Size the splint. It should extend part way up the thigh and part way down the lower leg. The length will partially depend on the extent of the knee injury. The more severe, the longer you will want to make the splint. If possible, fold a piece of webbing into the splint, along the top (we’ll return to this in Step 2).
• Place cravats (or whatever you’ll use to tie the splint) under the splint so they’re ready to be used.
• Pad the splint

Step 2: Applying the splint

• Move the splint under the patient’s leg and have your helper bend the splint around the leg. Pad any void spaces and under the knee. Keeping a slight bend in the knee from the start makes the splint slightly articulated and keeps the splint much more comfortable for the patient.
• Bend the splint around the knee, creating a frame, and secure the splint with cravats. Keep the cravats as wide as possible over the leg and avoid placing a cravat over the knee itself. All knots should be on the outside of the leg.

Usable Ankle Injuries

The splint for an ankle injury depends on how severe it is. Often, simply leaving the boot on and having the patient walk carefully with a trekking pole is all that is required. For people who chronically roll their ankles, prevention is key. Make sure they wear tall, supportive boots or tape their ankles before going out. For more severe injuries, try the following splint.

Step 1: Prepare the splint, and apply it to the boot with an ankle hitch and wrap.

• Pad the patient’s ankle. Cut out a piece of foam pad (or use a SAM splint) to use as an inner splint. This splint should extend from just above the bottom of the heel to mid calf.
• The ankle hitch secures the splint to the foot. Lay a long cravat (or two tied together) in an S-shape over the front of the ankle. Pull the tails of the S around the back of the ankle and through the newly created loops. Tighten the hitch by pulling down on both ends, then tie the ends of the cravat together on the outside of the foot. There should now be a stirrup on the instep of the patients boot.
• Wrap up the splint (from ankle to calf) with cravats, an ace bandage, or strips of fabric.

Step 2: Apply figure-eights.

• A figure eight locks the heel into place, providing great stability. Take a cravat, and lay it behind the heel. Now take the ends and cross them in front of the patient’s ankle, then down under the foot, then back over the front of the ankle in a figure-eight pattern. Do this two more times, or until the patient says her ankle feels secure, then tie the ends of the figure-eight together. You now have a solid walking ankle splint. Note: The only downside of this splint is that you don’t have access to the patient’s foot to check circulation. Ask him to wiggle his toes and occasionally take the splint off.

Unusable Leg Injuries (knee injuries, lower leg injuries)

Unusable knee injuries require a longer, stiffer splint that immobilizes the ankle.

Step 1: Preparing the splint

• Follow the same procedure as the usable injury example, but this time the splint should extend to the upper thigh several inches below the crotch (have the patient put the splint in place if you two don’t know each other well) and down past the foot. Again, a foam sleeping pad is perfect for this.

Step 2: Applying the splint

• Apply the splint following the same procedure as in the usable knee injury example. Now you’ve made a fairly rigid frame but still have a bunch of extra pad, and the patient’s ankle is still flopping around like a dead fish. Don’t worry. Place a cravat at the bottom of the pad, and roll the cravat up into the pad until you hit the patient’s foot. Now, bend the ends of the pad up and tie them together with the cravat (or any sort of lashing), creating a boot. Thread another cravat through the one you just tied and secure this one around the ankle.
• Pad any gaps around the ankle, and finish by wrapping an ace bandage or a few more cravats around the lower part of the splint. Bomber!

A note on other lower-extremity splints:

It’s possible to make a sweet backcountry traction splint for a femur fracture, which would make even MacGyver all hot and bothered, but that’s beyond the scope of this article. If you want to learn, take a Wilderness First Responder or Wilderness EMT course. In fact, anyone venturing into the backcountry should at least have a Wilderness First Aid course, if not a WFR.

A note on improvised stretchers:

If an injury is not usable, you’ll either have to call search and rescue or carry the victim out yourself on a makeshift stretcher. With enough materials for lashing and five or six people, you can make a surprisingly stable litter out of a few sturdy logs and a bit of creative engineering. Just remember to make absolutely sure the stretcher will hold the victim’s weight. If you want to learn more, take a Wilderness First Responder or EMT course. Do you see a pattern emerging here?

The last word:

These tips and techniques show you a few ways to make splints, but by no means are they definitive. As long as a splint makes the patient more comfortable and prevents further injury, you’ve achieved the goal. Remember: be creative, practice … and take a first aid course.

Related Posts:

• Backcountry Travel and the Herding Mentality
• Improvised Splints – Part II: Wrist, Hand, and Forearm
• Improvised Splints – Part I: Basic Principles

Tags: outdoor survival, safety, survival, wilderness survival