Fractured legs are exceptionally painful and can be caused by a direct blow to the leg or an indirect fall. The most common bones to break are the tibia and fibula bones of the lower leg. A complete break or fracture will lead to high levels of pain at the site of the injury, and in many cases movement will become immobilized. If this happens on a mountain top then the condition can quickly become life threatening. Keeping your first aid hat on at this time might just save a life.
The most common cause of a fractured leg on a mountain is from a fall. Mountains are fraught with dangers ranging from hidden crevasses to unstable rock faces. Some expeditions require near constant concentration for months on end in order to avoid any potential disasters. If a mountaineer falls hard onto their leg then the compression on the leg bones can be enough to cause them to snap. The bone can either break within the skin (closed) or through the skin (open), and in both cases will cause movement to be immobilized.
There is no bigger danger on a mountain than losing the capacity to move. They are often cold wind swept environments that require their inhabitants to move up and retreat quickly when required. By keeping moving you are not only keeping yourself warm, but also are able to retreat from bad weather and get to lower more oxygen plentiful levels. If a mountaineer is lying motionless with a fractured leg they are more susceptible to life threatening hypothermia. Owing to the difficult nature of climbing it is also common for fellow peers to be unable to move a casualty. At high altitudes and on difficult terrain it can be near impossible to carry a climbers weight back down a mountain without killing the two of you.
Applying first aid principles could be the difference between someone surviving and not surviving a fracture on a mountaintop. If you have witnessed an accident or come across someone immobilized then a physical examination of the injured leg is required. If the person complains of severe pain when you touch the site or if there is a physical deformity in the leg then a fracture should be suspected. If there is still uncertainty then you can try and get the casualty to put weight in the leg in a bid to walk off. If this is not possible then it is more than likely a fracture has occurred and the thinking in the next minutes and hours could be the difference between life and death.
It is likely that the casualty will go into a state of shock where there blood pressure drops. At this point it is important to keep them warm by insulating the ground underneath them, and raising the legs if possible to get the blood back to the heart. If the fracture is broken through the skin then the blood loss will need to be controlled using bandages. In many cases the natural survival capacity of the body will help assist in reducing blood loss.
The next stage is to interact with the casualty in a fashion that shows you are confident and in control of the situation. Your biggest fears about the situation should stay within as the casualty will be feeling vulnerable and pessimistic. Now is the time to work out roughly where you are and make the call to the emergency services. There could be a long wait so if possible a tent should be erected or an emergency bivouac set up to keep both of you warm. Don't compromise your own health at any time. It is much harder for mountain rescue to recover two casualties than just one.
In certain incredibly frightening situations sometimes no help will ever be available. There is no text book or manual to describe how you should deal with this situation. Many a climber has died as a result of trying to pull another off a mountain. Using your skills as a climber to lower the casualty down a rock face is possible depending on the environment. This should always be a complete last resort when absolutely no help is possible. It is always safer to bivouac and await rescue.
