If fracture is possible, support the limb in its existing position, keep it still and cool for no more than 20 minutes at a time
Treat limb injury as a possible fracture: standing or moving does not exclude one, and imaging is needed to confirm it. Support it with hands, a sling or a board in its current position. Apply cold promptly for no more than 20 minutes at a time. Do not straighten it yourself. If bone breaks through the skin, control bleeding and cover with a clean dressing without pushing it back.
What it takes
Free improvised supports include a board, rolled magazine or clothing. Put cloth between cold packs and skin.
What you may gain
IFRC's 2025 guidance says limb injuries should initially be treated as possible fractures and identifies X-ray as the accurate confirmation method; when uncertain, manage as fracture. Immobilization minimizes movement and pain. Cold application should last no more than 20 continuous minutes to reduce pain without skin damage. Bleeding from a long-bone fracture such as the femur can be life-threatening. Marked pain/swelling, shock, femoral injury or obvious deformity warrants emergency help. Field reduction of an angulated fracture requires both a remote/resource-limited setting with a cold/pale distal limb or inability to immobilize for transport, and a trained rescuer. Open-fracture priorities are bleeding control and infection prevention.
Context & considerations
Grade B because these are accepted practices. Prehospital femoral traction has only one retrospective supporting study with very low-certainty evidence: less transfusion within 24 hours and shorter admission, with mortality/complication differences too uncertain to resolve. No evidence was found comparing reduction before immobilization with immobilization as found. Correct three misconceptions: walking does not exclude fracture; use cold rather than heat or alternating heat/cold; and a sprain does not improve by forcing it to “loosen up”—rest first. See moving older people after falls, one-leg swelling after a cast or bed rest, injury-disability assessment and disability certification.
Research & references
International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025, pages 301–302. https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf