Many EMS programs do not recommend prehospital reduction of deformity of an injured extremity. If the deformity is near a joint (suggesting the possibility of dislocation), this is certainly good advice. Injudicious manipulation may convert a pure dislocation to a fracture-dislocation. Even if a fracture already exists, there will be no way to prove it was not caused by the manipulation.
A circumstance in which prehospital reduction of obvious fractures along the shaft of a long bone can be justified is the absence of a distal pulse. Minutes count in such cases. If reduction is attempted, it should be performed by means of longitudinal traction.
In the absence of a common standard, the indications for reduction of deformity by prehospital personnel ultimately remain at the discretion of the supervising EMS program.
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