What to do if you break your leg in the middle of nowhere

Know how to improvise, but try to be prepared.

mountains
Centennial Mountains. This 28,000-acre range borders southwest Montana and Idaho.Bob Wick, BLM California

So you're out in the wilderness, enjoying the fresh air and leaving civilization far behind, when suddenly your friend slips and—crack! Maybe he falls onto his outstretched hand, or she lands on her leg. Either way, you have a bad feeling a bone might be broken. Your friend is in a lot of pain, and you're far from anyone who might help you.

What now? Fortunately, there are a few things you can do to treat a broken limb all on your own. “Splinting is really the mainstay of therapy in the wilderness as it is in the urban environment,” says Eric Weiss, a professor of emergency medicine at the Stanford University School of Medicine.

Of course, the guidelines below aren't hard and fast rules—your circumstances may vary. But if you educate yourself and make sure you're prepped for disaster when you set out on your trail, you can help keep things from getting too dire.

Assessing the injury

For any injury, the first thing you must do is figure out is how quickly you need help and whether you can reach it yourself. Ideally, you'll be able to call for aid on your mobile or satellite phone, radio, or GPS tracker if it has a built-in emergency signal. When you call for help, be concise and direct. "Use your communication time wisely—say exactly who you are and where you think you are and what the medical scenario is," says David Townes, an associate professor in the Division of Emergency Medicine at the University of Washington School of Medicine in Seattle. "You may have cell coverage and it may disappear, or you may run out of batteries."

But it can be difficult to gauge how seriously someone has been hurt. Injuries to the head, neck, chest, abdomen, and pelvis are especially tricky. “It’s really hard to tell, even for a trained professional, in an austere environment,” Townes says.

Fortunately, arm and leg injuries tend to be more straightforward. There are a few signs that a bone is broken, or fractured. The most obvious one is if your bone is sticking through the skin. But there are closed fractures as well—when the bone breaks but does not pierce the skin.

If you heard a crack, or can hear or feel grating when the injured area is touched or moved, the bone might be broken. Another sign is that the limb hurts too much for the person to use, or can move at a point where there is no joint. “If you push up towards the knee, away from the injury site...and the person says, ooh, it hurts down by the ankle, then that’s more likely than not to be a broken bone,” Weiss says.

The limb can appear deformed—it might be shorter than its uninjured partner, or rotated at an odd angle. There may also be rapid swelling and bruising. "Blood is made in the bone marrow; if you break a bone, that blood will leak out of the bone through the break and will cause a black and blue discoloration in the skin," Weiss says.

But these signs may not appear in the case of a break, and may even show up in the absence of a fracture if you've sustained a bad enough soft tissue inhury. You might not be able to differentiate between a broken bone and a sprain or bruised bone. If you’re not sure, don’t panic. “You don’t have access to x-rays out in the wilderness,” Weiss says. “When in doubt you should assume it’s broken and splint the extremity.”

Splinting is generally very safe if done correctly. “You’re unlikely to do damage by splinting, unless you put the splint on too tight,” Townes says.

Before you whip out a splint, however, there are a few things you must do first.

injured hiker
Ouch.Deposit Photos

An open fracture—where the bone is jutting through the skin—comes with a higher chance of bleeding and infection. If the wound is bleeding, apply direct pressure and rinse it off with sterile water before putting a dressing on it. Just try to flush out any dirt; don't scrub or rub the area.

You must also check to make sure the fracture isn't paired with a more serious injury to the nerves or blood vessels.

If you know how, check to see if the person has a pulse below the injury. Make sure the limb isn't turning cold or bluish. You can also check what's called capillary refill. Normally, if you pinch down on your finger or toenail, it will turn white as the blood is pushed out. "When you let go it just pinks right up in less than two seconds," Townes says. But if it takes longer than a few seconds to return to its normal color, that indicates the person could have injured a blood vessel.

It’s also critical to check for nerve damage. Make sure the injured person can feel sensation normally in their extremities farther down from the injury. Ask if they truly can’t move their limb, or if they cannot move it because it hurts so much.

If someone in your group has broken a bone and there’s evidence they’ve also injured a nerve or blood vessel, the situation is more urgent. “You need to get help in a matter of hours,” Townes says.

As you prepare to splint the injury, it’s better if the injured person keeps their shirt or pants on. Removing their clothes could jostle the broken bone more and leave them less protected from the elements. So if you can, cut away the clothing right around the injury so you can examine it. Also take off any jewelry near the injury, like watches, bracelets, or rings. “You’re going to get swelling and they’re going to become little tourniquets,” Weiss says. “I've seen that happen, where nobody’s thinking about taking off the wedding ring, and they come in with a broken wrist and all of a sudden it’s impossible to get off and has to be cut off.”

Splinting

You should splint the broken arm or leg in its normal position. “If a limb is markedly deformed and you think that circulation to the extremity is impaired, then I would consider realigning, or straightening, the limb,” Weiss says. That involves gently pulling on it below the fracture while another person holds the limb steady at a point above the injury. However, Weiss advises, stop if the injured person feels a dramatic increase in pain.

This move is not the same as setting the bone. “I’m trying to improve the circulation and the sensation…more than I’m trying to get the bones to line up to heal better, because you can wait for that,” Weiss says.

Realigning a broken limb can be challenging, though. Deciding how hard to try to try to restore the limb to its normal position may call for additional training, Townes says.

So it's finally time to splint. Putting a splint on a broken bone keeps it from moving around and prevents further injury to the muscles, nerves, and blood vessels. It also can quickly and sharply reduce a person's pain. Your splint should be rigid, well padded, and long enough to immobilize the joints above and below the fracture.

Townes recommends that people going into the backcountry carry ready-made splints with them. These flexible aluminum splints are light, cheap, and don't take up much room.

But if you haven't got one, you'll have to improvise. Anything long and rigid can be called into duty—a ski pole, hiking staff, tent pole, the aluminum stays from a backpack, or even a stick. Ideally you want two poles, one on either side of the injury, so your splint resembles a pair of sugar tongs, Weiss says. In a pinch, you can splint someone's injured arm against their chest, or splint their broken leg to the uninjured limb.

Make sure the splint is well padded with gauze, clothing, or whatever else is on hand. Finally, tie it in places with bandages, or improvise with strips of clothing or pack straps. Friction can rub skin away pretty quickly, so make sure the splint isn't too tight.

Before you try putting the splint on the broken bone, practice on the person's uninjured side. "People will put it on and go, oh, that's not right, and take it off and you're causing unnecessary pain," Weiss says. Once you are satisfied with the splint, transfer it to the side with the broken bone. You can take a little time to get it right; if there isn't an injured blood vessel or nerve, or other critical injury, then the situation is probably not immediately urgent.

traction splint
A traction splint, improvised during a wilderness medicine class.David Townes

Some fractures are particularly complicated—the thighbone is the biggest bone in the body and takes a lot of force to break, for example. When it does break, the muscles will contract and can cause pieces of bone to overlap. This situation may call for a device called a traction splint. "It allows you to pull…the leg so it straightens out," Weiss says.

Traction splints often don’t stay in place, even when search and rescue teams apply them and use ready-made ones, Townes says. So it’s going to be tough to improvise. Still, Weiss recalls, he once helped improvise a traction splint out of a canoe paddle.

The waiting game

Once the splint is on, you’re not done. While you wait for help, check for nerve and blood vessel problems every hour or so. Keep an eye on the splint to make sure the swelling inside hasn’t cut off circulation in the limb.

If you have over-the-counter pain meds, you can use them. Anti-inflammatory drugs like ibuprofen (Advil or Motrin) can interfere with blood clotting, so they may make bleeding a little worse. However, Townes says, this is not a big concern. If you have a choice, drugs like acetaminophen (Tylenol) may be ideal. But if someone were in pain, Townes says, he would offer them ibuprofen as well.

Of course, all of the above assumes the injured party has at least one pair of helping hands. If you’re by yourself, the procedure is the same—it’s just going to be harder to carry off (especially if you’ve broken your dominant arm).

If you cannot reach help or know that it will not arrive for some time, you may be stuck unexpectedly spending the night outside. Every situation is different, but finding shelter and securing water are key.

“In general, keeping yourself dry and warm is the primary priority,” Townes says. People who are seriously injured lose heat rapidly, so keeping the injured area warm is paramount. “One of the mistakes people make is…they forget to insulate between themselves and the ground,” Townes says. “You can be covered in a big blanket and a sleeping bag, but you lose a tremendous amount of heat between the ground and your body.” So put some kind of covering down where you will be resting.

Best of all, plan ahead. “Improvisation, while it’s taught a lot in wilderness medicine, is still challenging,” Townes says. “That needs to be very carefully matched with proper preparation.”

It’s best to go into the wilderness with a buddy. But if you are alone, make sure that someone knows where you are supposed to be in your journey at all times so you don’t end up stranded for days with a broken bone. Know which parts of your trek have cell coverage, and what you would have to do to get help or hobble out if you got injured at any particular point. Bring what you need to splint a broken bone—if you're going it alone, practicing on a particularly difficult stretch of limb wouldn't be a bad idea. Be able to read a map and compass, and be ready for an unexpected night outside.

You can’t prepare for every misadventure, but some problems are common. “If you could splint an extremity, you can purify water, you can keep yourself warm and dry, and you can figure out how I get help, those go a long way to not needing to improvise,” Townes says.

If you're heading into remote territory, it's a good idea to get a little wilderness medicine training, whether it's a 4-hour class or a longer endeavor. You can even watch videos online that explain how to put a splint on. It's not ideal to learn these kinds of skills without proper supervision, Townes says, but it's better than nothing.