Wound of the Month: Compound Fracture

Objective: Using moulage to create a realistic compound fracture wound. (see Figure 1)

Time: 3-5 minutes

Skill Level: Beginner

Supplies: (Shop www.moulageconcepts.com for all your moulage needs!)

• Silifex Gel set
• Blood gel
• Translucent powder
• Latex, white
• Blood wax

Equipment

• Palette knives
• Laminated board
• Blush brush
• Paint brush, small
• Toothpick
• Blow dryer
• Scissors, small

Technique: (see Figure 2)?

Using separate palette knives, remove a small amount (approximately the size of a dime) of Silifex gel A & B in equal portions and place on palette board to activate.  

Using the back of palette knife, combine ingredients until fully mixed. Note: To ensure long term integrity of both products, use separate palette knives or utensils to remove product from each container prior to combining on palette board, as the combination of products creates a chemical reaction that readies it for use.

Using a palette knife or your fingers, begin spreading silifex over desired fracture site, creating a large, thin layer, approximately 2 x 2 inches in diameter. To create a natural bone fracture protrusion, spread silifex over a prominent bony area, such as the wrist or ankle. (see Figure 3)

Using a blow dryer on low-cool, gently dry the silifex until set, approximately 30 seconds, or allow to air dry 2-3 minutes or until dry to the touch. (see Figure 4)

To set silifex and ready for make-up, carefully coat application with translucent powder or skin tone make-up. Using a make-up blush brush that has been dipped in translucent powder (gently tap edge of brush to container to release the excess powder) brush the silifex until surface is matte or no longer shiny.

Using scissors to create an opening, gently remove a small opening around the perimeter of the natural bone, exposing the natural skin below.  Continue to remove silifex until entire bony prominence is visible.

Using a small paint brush that has been dipped in white latex, apply several coats of color to the (now exposed) wrist bone, allowing coats to dry completely between applications.

Using a toothpick, gently lift the silifex along the inside opening (around the perimeter of the wristbone), by wedging the tip under the silifex and lifting slightly upward. Gently push small pieces (approximately the size of a bb) of blood wax under the (silifex) rim, (where the silifex and latex meet) to create height and tearing at the exposed bone.

Using red Moulage gel, coat the inside perimeter of the bone, along the skin tear and dripping down the side of the arm. 

Using a make-up sponge that has been dipped in red make-up, create fresh bruising discoloration by lightly applying make-up to the surrounding skin.

Quick Fix

Do you want to show more bone protruding from the wound? Gently glue a small rounded piece of (dried) white clay that has been broken along the edge to create jaggedness. Using latex, adhere dried clay to skin and allow to fully set before proceeding with the recipe. Apply silifex over skin and clay as instructed in recipe. 

Training Scenario

Dispatch: Medic 15, Respond Code 3 to 5198 4th Street; Gridley Elementary School, unknown injuries. Nearest cross street, Billie Road. Gridley County Fire responding. 0815 hrs. Dispatch clear.

On Scene: Using a make-up sponge, apply white makeup to the face of (child) victim, blending well. Apply compound fracture to ankle of victim. Place victim on the ground, near the swing set area or outdoor recess compound; place a small amount of blood on shoes, socks and area around fractured ankle. Apply first-degree abrasions to palm of hands, elbows and side of leg near fracture. Using sweat mixture, create tear streaks down the face of victim. Advise patient to cry, wince and be very frightened over the blood. 

Use in Conjunction With: Blisters, clear; blood; sweat; abrasions; fresh bruising.

Cleanup and Storage

Advise victim to carefully remove the compound fracture from their skin; using their fingers, lift the wound around the edges of the silifex. Using a gentle upward motion, continue to peel away the wound until all silifex has released from the skin. Using a soft, clean cloth or make-up remover towelette, remove the make-up and any remaining product residue from the skin. 

Bobbie Merica is the author of Medical Moulage: How to Make Your Simulations Come Alive, Moulage! Bridging the Gap in Simulation and Moulage Magic! Theatrical Tricks to Bring Simulation to Life. All works are based on her popular Moulage Mastery! Bridging the Gap^TM in Simulation workshops. She received her certification in Moulage-The Art of Injury Simulation; Biological/Chemical/Terrorism and WMD terrorism training through TEEX. Upon discovering the absence of moulage specific to a clinical/hospital setting, she designed and implemented the first of a series of 3D clinical wounds, moulage kits and courses that she teaches all over the country. She began her career as a simulation technologist with California State University, Chico, where her collaborative work in the development of the Rural Northern California Simulation Center earned runner-up honors in Advance magazine 2009 Best Nursing Team contest. She is a contributing author for EMS World and HealthySimulations.com, and medical moulage & trauma expert for the Bureau of Public Health Emergency Preparedness, AZ. For more information, visit www.moulageconcepts.com.