Extremity injuries are seldom life-threatening, but are often associated with significant pain. Assess all four extremities for tenderness, swelling, instability, deformity, loss of motor function and loss of sensory function. It is important to assess the patient for pulse, motor function and sensation distal to the injury. If pulses are absent, this requires immediate attention and transport. Long bone fractures require significant force and should initiate a high index of suspicion for other injuries and possible damage to the surrounding vessels. Recall that long bone fractures can result in significant blood loss in children. The most common cause of peripheral vascular injury is penetrating trauma. However, fracture dislocations of the tibia, fibula, femur and humerus have the potential for associated arterial vascular injury.