A 72-year-old male crashed into a pole. He cannot move or straighten his right leg, and the distal pulse is absent. He yells in pain when you attempt to manipulate the leg. What should you do?

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When a limb is severely deformed, the patient has significant pain on manipulation, and distal perfusion is lost, this points to a limb-threatening injury where realignment can restore blood flow. The priority is to relieve pain and promptly reduce the dislocation or deformity to relieve compression on the vessels. Administering morphine helps control the pain and muscle spasm to make reduction safer. After analgesia, gently and carefully straighten the leg to realign the joint and relieve vascular compromise, then immobilize the limb and rapidly transport for definitive care. Traction splinting isn’t the best choice here because the distal pulse is absent, and simply transporting without attempting alignment could prolong ischemia.