> For the complete documentation index, see [llms.txt](https://handbook.teddwa.xyz/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://handbook.teddwa.xyz/broken-limbs/broken-legs-ankles-and-feet.md).

# Broken legs, ankles, and feet

Assess circulation, immobilize the lower limb, and identify trauma threats.

### Immediate actions

1. Complete the primary assessment (ABCs) and control life threatening bleeding.
2. Expose the limb and assess deformity, swelling, wounds, and tenderness.
3. Cover open fractures with a sterile dressing and control bleeding without moving exposed bone.

Consider associated pelvic, spinal, or internal injury after significant trauma. Minimize movement and follow trauma protocols.

### Check distal function

Assess and document distal pulses, skin color, warmth, capillary refill, sensation, and movement. Compare both limbs when practical.

Absent pulses, increasing pain, numbness, paralysis, or pale and cool skin require urgent reassessment and transport.

Watch for compartment syndrome: pain out of proportion, pain with passive movement, tense swelling, numbness, weakness, or reduced distal perfusion.

### Immobilize

Stabilize the limb in the position found. Immobilize the joint above and below the suspected fracture.

Use padded rigid splints, vacuum splints, or an approved immobilization device. Secure the device without restricting circulation. Recheck distal function after splinting.

Use a traction splint for an isolated mid shaft femur fracture. Do not use it when pelvic, knee, lower leg, ankle, or multi system injury is suspected.

### BLS and ALS care

Apply a cold pack over a barrier if appropriate. Prevent heat loss and monitor for shock.

ALS should treat severe pain with fentanyl, morphine, or ketamine when appropriate. Establish IV or IO access for femur fractures, open fractures, or suspected shock.

Treat hypotension with warmed isotonic crystalloid and reassess mental status, pulse, blood pressure, skin signs, and distal function.

### Transport

Transport urgently for open fractures, femur fractures, neurovascular compromise, severe deformity, multiple injuries, or suspected pelvic injury. Continue reassessment throughout transport.


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