Wilderness / low-resource medicine question: What can be done about misaligned/displaced broken ribs when surgery is not going to be available for a while (if at all)?
It takes a LOT of force to cause a rib fracture to become displaced, if only because there is a lot of muscle and other ribs that naturally form a nice splint. The presence of displaced rib fractures indicate that so much force was applied to the chest that there is probably significant damage below the surface.
This damage includes severely bruised or even punctured lung, pneumo- or hemothorax (blood or air building up in the chest cavity), pericardial effusion (buildup of fluid around the heart that puts pressure on it so it can't beat well), and depending on where the impact occurred, damage to the big bleedy organs (liver or spleen).
For this reason, the presence of multiple displaced rib fractures would be a "go fast" situation (usually a helicopter evacuation if one was available).
There's not a ton you can do about internal injuries in a wilderness setting. If you happen to have a 14g IV catheter and someone trained at the paramedic level they might be able to do a "chest dart" for a pneumothorax, but other than that, everything else needs surgery or something that's impossible to do without at least an EKG available.
The only thing you really can do at a lower level of training is to tape a bulky dressing snugly over the ribs. This can be a pillow or folded blanket taped just over the area of injury (not all the way around the chest). This helps decrease pain and makes breathing easier.
After this, treatment would be using any pain medication that is available (except aspirin, due to bleeding risk), encouraging the person to breathe as deeply as possible, and getting them out of the wilderness.
