Realigning a Deformed Extremity

Grasp elbow and manually apply distal traction.
Plaster splint in alignment.
Secure with sling.

Manually apply distal traction through wrist, holding elbow and applying counter-traction.
Splint and elevate.

Realign with manual traction through ankle (if tib and fib not #'d)
As muscle spasm is overcome, leg will straighten and rotational deformity can be corrected.
May take several minutes depending on pt size.

Manually apply distal traction at ankle and countertraction above knee.
(Provided femur is intact).

* Immediately consult relevant surgeon if neurovascular injury.
* If splinting worsens neurovascular status, remove splint and return position of limb where nv status maximised; then immobilise in that position.