ATP 4-02.11 Reference

FRACTURES & SPLINTING TECHNIQUES

Source: ATP 4-02.11, Chapter 13 — Fractures and Splinting, 23 March 2026

Key Points

  • Splinting is the "S" in MARCH-PAWS — secondary priority
  • Immobilize the joint above AND below the fracture
  • Check CSM (Circulation, Sensation, Movement) before and after splinting
  • CoTCCC-recommended: 36-inch semi-rigid splint (malleable aluminum/foam)
  • If too tight: numbness, tingling, increased pain, pale/blue fingers/toes → loosen
  • Do NOT place cravat on the fracture site
  • Do NOT manipulate the fracture site excessively
  • Splinting S in MARCH-PAWS is Tier 2 (CLS) skill

Common Mistakes

  • Applying cravat directly over fracture site
  • Splinting without checking distal pulse first
  • Wrapping too tightly — cuts off circulation
  • Placing splint ends at groin (interferes with blood flow)
  • Not immobilizing joints above and below the fracture
  • Not reassessing CSM after splint is applied

CSM Check

Check distal to fracture — before and after splinting:

  • C — Circulation: check distal pulse, skin color, capillary refill
  • S — Sensation: can they feel you touching distal fingers/toes?
  • M — Movement: can they move the fingers/toes?

Loss of any CSM after splinting = loosen immediately and reassess.

Critical Splinting Principle

Splinting is crucial to immobilize the affected area, preventing further damage, and minimizing pain. Ensure joints above and below the fracture are immobilized. Always check pulse, sensation, and movement before and after applying the splint. If there are signs of poor circulation after splinting, loosen the splint, reposition, and reapply. (ATP 4-02.11, paras 13-13 to 13-14)

Types of Fractures

Type Description Key Concern
Closed Fracture No external wound associated with the fracture — skin intact Swelling, neurovascular compromise
Open Fracture Break in the skin with bone often protruding Infection risk, hemorrhage, do NOT push bone back in

Warning Signs of a Fracture

  • Significant pain along with marked swelling
  • An audible or perceived "snap"
  • Different length or shape of limb
  • Loss of pulse or sensation in the injured arm or leg
  • Crepitus — a crackling or popping sound/sensation under the skin

Before Splinting — Pre-Application Steps

  1. 1

    Identify the location of the fracture.

  2. 2

    Check CSM distal to the fracture — pulse, sensation, movement. Document findings.

  3. 3

    Control any bleeding from an open fracture with a dressing before splinting.

  4. 4

    Mold the semi-rigid splint to the contour of the unaffected limb if possible — avoids manipulating the injured limb.

Leg Fracture Splinting

  1. 1

    Apply the splint to the injured extremity with the limb in the position of function or normal resting position.

  2. 2

    Secure the splint with cravats or gauze. Do NOT apply a cravat on the fracture site — place cravats above and below the fracture. Do not place splint ends at the groin.

  3. 3

    Ensure the joints above and below the fracture are immobilized.

  4. 4

    Recheck CSM after applying the splint. If signs of poor circulation (coolness, numbness, absent pulse, blue/pale digits): loosen, reposition, reapply.

Arm Fracture Splinting

  1. 1

    If possible, have the casualty support their injured arm while preparing equipment to reduce movement.

  2. 2

    Place rigid objects (or splint) on each side of the injured arm or forearm. Position so the joint above and below the fracture are immobilized.

  3. 3

    Apply padding between the arm and splint. Secure with cravats or gauze — use square knots tied away from the body on the splint. If possible, two cravats above and two below the fracture site.

  4. 4

    Apply a sling and swathe to further immobilize against the body. The sling supports the forearm; the swathe binds the arm to the trunk.

  5. 5

    Check pulses distal to the extremity before and after application.

Improvised Splinting

Splints may be improvised from boards, poles, sticks, tree limbs, or cardboard. If nothing is available: (ATP 4-02.11, para 13-22)

  • For arm fracture: use the chest wall (anatomical splinting) — swathe arm to torso
  • For leg fracture: bind the injured leg to the uninjured leg (anatomical splinting)
  • Padding may be improvised from jacket, blanket, poncho, or shelter half
  • Securing materials: belts, strips of clothing, roller gauze, or IV tubing

ATP 4-02.11 Source

Chapter 13: Fractures and Splinting — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.

See It in Practice — ESB Tasks

These ESB Medical Lane tasks apply this doctrine directly:

M10: Fracture & Burn
Burn Injury Management Abdominal & Thoracic Wounds