Extremity Immobilisation
1. Deal with ABCDEs / life threats first.

2. Remove clothing, expose pt including extremities.  Remove jewellery, watches.  Prevent hypothermia.

3. Assess neurovascular status: pulses, haemorrhage, motor / sensory exam.

4. Cover open wounds with sterile dressings.

5. Select splint: should immobilise # at jt above and below.

6. Pad any bony prominences that will be covered up.

7. Splint extremity in position in which distal pulses are present.  If distal pulses absent, attempt to realign extremity once.  Apply gentle traction until splinting secured.

8. The extremity is splinted if normally aligned.  If malaligned, realign then splint.  If not easily realigned, spint in position in which it is found.

9.  Obtain orthopaedic consult.

10. Document neurovascular status before and after every maninpulation or splint application.

11. Administer tetanus prophylaxis.
Traction Splinting

1. Need 2 people: one for extremity, one for splint.

2. Conduct up to 4 above.

3. Clean exposed bone / muscle of dirt and debris and document.

4. Determine length of splint by measuring uninjured leg.  Place upper cusioned ring under buttock and adjacent to ischial tuberosity.  Place distal end beyond ankle by 15cm.  Stap to support thigh and calf.

5.  Align femur by manually applying traction through the ankle.  Then gently elevate the leg to allow assistant to slide splint under extremity so that padded portion rests against ischial tuberosity.  Reassuess nv status.

6. Position ankle htch around ankle & foot while assistant maintains manual leg traction.  Bottom strap should be slightly shorter than / same length as upper 2 crossing straps.

7.  Attach ankle hitch to traction hook while assistant maintains manual traction and support.  Apply traction in increments using the windlass knob until extremity appears stable, or pain and spasm relieved.

8.  Reassess nv status.  Release traction if nv status worse.  Document.

9.  Secure remaining straps.  Tetanus.