Realignment Indication states that realignment should be performed:

• A. Realignment should occur regardless of pulse if there is deformity
• B. Realignment should occur only with no distal pulse
• C. Realignment is never performed in the field
• D. Only if no distal pulse and protocol allows

Answer: (D)

The key idea is that limb realignment in the field is pursued when the limb is at risk due to loss of blood flow. If a distal pulse is still present, attempting to realign the deformity can risk damaging vessels, nerves, or soft tissues and may worsen perfusion. Therefore, realignment is avoided when a distal pulse exists, unless the protocol explicitly allows and there is a compelling reason to proceed.

When there is no distal pulse, the deformity may be contributing to limb ischemia, and realignment can relieve extrinsic pressure and help restore perfusion, but this should only be done under the provider’s protocol, with appropriate analgesia and technique.

Thus, the guideline is to perform realignment only if there is no distal pulse and the protocol permits.