A 22-year-old female knee injury with severe pain; knee is flexed and severely deformed; leg cold to the touch and distal pulse not palpated. You should:

• A. Apply gentle longitudinal traction as you straighten her leg and then apply a traction splint.
• B. Manually stabilize her injury and contact medical control for further stabilization instructions.
• C. Carefully straighten her leg until you restore a distal pulse and then apply padded board splints.
• D. Place a pillow behind her knee and stabilize the injury by applying padded board splints.

Answer: (B)

When a knee injury presents with severe deformity, the leg is cold, and there is no distal pulse, the priority is to prevent further harm and get definitive care quickly. This situation suggests a limb-threatening injury, such as a knee dislocation or severe fracture with possible vascular compromise. Attempting to straighten or manipulate the knee can worsen displacement and damage arterial flow, potentially making the ischemia worse. The safest immediate step is to manually stabilize the limb in the position found to minimize movement and protect the vessels, while contacting medical control for further stabilization instructions and rapid transport. This approach keeps the leg from deteriorating and ensures you receive guidance on advanced care.

Traction or straightening efforts are not appropriate here because they can aggravate the injury and do not guarantee restoration of perfusion; attempting to restore a pulse by manipulation is unreliable and risky. Simply placing a pillow and splinting without addressing the potential vascular injury can allow continued ischemia and poor outcomes.