Definition and Overview
A fracture reduction is an orthopedic procedure used in the treatment of bone fractures and dislocations. Its purpose is to correct problems that affect the alignment of the bones. While the term “reduction” implies a removal or decrease, the etymology of the word itself translates to “returning back to normal”. Thus, the procedure refers to the restoration of the proper alignment of the bones in the event of a displacement or a fracture.
Who Should Undergo and Expected Results
Fracture reduction is recommended for those whose bones have become displaced or misaligned due to a variety of causes including trauma and sports-related injuries, or as a result of the following bone-related diseases:
- Osteoporosis, a bone disease caused by calcium deficiency
- Osteomalacia, or the weakening of the bones
- Osteogenesis imperfecta, or brittle bone disease
- Osteosarcoma, a cancer of the bone that affects the shinbone, thigh bone, or the upper arm bone
- Paget’s disease of the bone, a bone disease that disrupts the bone’s ability to repair and renew, causing them to become weak and deformed
- Ewing’s sarcoma, or malignant tumors that forms in or around the bones, usually affecting the long bones of the arms and legs
The risk of suffering a fracture also increases with age, due to the bone’s natural tendency to become weaker and more fragile as a person gets older.
Without proper treatment, fractures may cause chronic pain, disability, or reduced mobility. Fracture reduction is therefore a critical part of the treatment process due to the tendency of affected bones to develop a deformity during the healing process if the fragments are not properly re-aligned.
How is the Procedure Performed?
Depending on the severity of the condition and other factors, patients with bone fractures can be treated with either or a combination of closed and open fracture reduction procedures.
In a closed reduction, the displaced or fractured bone fragments are manipulated back into their proper position or alignment without surgically exposing them. This, however, has to be done immediately after the fracture occurs. During the procedure, traction is applied at or across the fractured bone to relax the surrounding muscles. This is followed by slowly manipulating the fragments back into place and stabilizing them with a cast or splint. In a modified version of the procedure, the affected body part is supported by a percutaneous wire or K-wire, a percutaneous screw, or an external fixator.
In an open reduction, a surgical incision is made to expose the fragments and put them back in their proper position. Unlike a closed reduction, which can be performed by an experienced and trained physician, only an orthopedic surgeon can perform an open reduction. This procedure is used for cases wherein a closed reduction is not possible. In almost all cases, a closed reduction procedure is usually the first attempt. If it fails to deliver the expected results, an open surgery will be performed.
Additionally, there are also some cases in which the newly reduced position of the fractured bone cannot be successfully held in place by external fixation techniques. Such cases require an open surgery to carry out an internal fixation procedure.
After a fracture has been successfully reduced, the patient undergoes an x-ray examination, among other tests, to make sure that the fractured bone has been replaced or restored accurately.
Possible Risks and Complications
Fracture reduction comes with certain risks and complications with pain being one of the biggest concerns. Thus, it is common for doctors to provide patients with numbing medications, such as short-acting anesthetic, mild sedative, or nerve block, prior to the procedure. Another common risk is the possibility of the reduced bone to move out of its place.
Other complications linked with fracture reduction include:
- Pulmonary embolism
- Wound infection
- The need for a revision of either the open reduction or the internal fixation, or both
These complications are more commonly observed in cases wherein the patient also suffers from other health conditions, such as diabetes, or when the patient is of advanced age.
Despite these risks, the overall rate of complications associated with fracture reduction, including open reduction procedures, is low.
“Closed reduction of a fractured bone.” Medline Plus. 11 June 2008. https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000521.htm
Buckley R. “General Principles of Fracture Care Treatment and Management.” Medscape. http://emedicine.medscape.com/article/1270717-treatment