Step One: Place Pivot-Trac^TM next to uninjured limb and disconnect the ischial strap and support straps. Loosen both (red) length adjusters and size splint for correct length while pivoting the ischial pad. Conform the pivot angle to match the bottom side angle (ischial tuberosity) of the injured limb. Retighten both (red) bi-pod heel stand in place.

Step Two: Apply EZ-HITCH^TM to the injured extremity. Position D-ring hooks at either side of the foot.

Step Three: Manually apply traction to the injured extremity.

Step Four: Disengage sliding traction lock. Push in traction knob (red) and extend traction spool strap.

Step Five: While manual traction is maintained, elevate the limb slightly while supporting the fracture site. Gently slide Pivot-Trac forward into the ischial tuberosity - establishing a firmly seated traction fulcrum.

Step Six: Connect traction strap clip to the EZ-HITCH D rings. Turn the ratchet knob in increments to apply mechanical traction. Maintain manual traction application until incremental mechanical force overrides manual effort. Continue traction therapy according to approved local protocol.

Step Seven: When satisfactory traction force is achieved, engage the sliding traction lock.

Step Eight: Connect remaining Pivot-trac support straps. Monitor and transport patient according to approved local protocol.