Your Health - Fracture Reduction

Fracture Reduction

(Setting a Fracture)

by Editorial Staff And Contributors

Definition

This procedure is done to return a broken bone to its proper alignment. There are two types of fracture reductions:

Closed reduction—bone is set without making an incision in the skin
Open reduction—involves cutting through the skin to realign the bones; used if the bone is in many pieces or difficult to reduce; screws and a plate may be needed to hold the fragments in place

Reasons for Procedure

Fracture reduction is done for the following reasons:

So that the bone can heal properly and more quickly
To decrease pain and prevent later deformity
To regain use of the bone and limb

Possible Complications

Complications are rare but no procedure is completely free of risk. If you are planning to have a fracture reduction, your doctor will review a list of possible complications, which may include:

Nerve damage
Infection
Bleeding
Fat particles from the bone marrow or blood clots from veins can dislodge and travel to the lung
Need for additional surgery if the bone does not heal properly
Reaction to anesthesia

Factors that may increase the risk of complications include:

Advanced age
Pre-existing medical condition
An open fracture (broken bone is sticking out of skin)
Diabetes
Use of steroid medicine
Smoking

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Physical exam
X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
Provide a splint for the broken bone to decrease the risk of additional injury

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)
If advised by your doctor, take antibiotics. You may be given antibiotics if you have an open fracture.
Arrange for a ride to and from the procedure. Also, arrange for help at home.
Eat a light meal the night before. Do not eat or drink anything after midnight.

Anesthesia

Your doctor may give you:

General anesthesia —blocks pain and keeps you asleep through the surgery
Local anesthesia—numbs the area; given as an injection (You may also be given a sedative.)

Description of the Procedure

Your doctor will use the closed or open method depending on the:

Type of fracture
Location of fracture

During a closed reduction, the bone fragments will be manipulated into their normal position. The doctor will apply traction and use a cast or splint to hold the bones in place. No incisions are needed.

With open reduction, the doctor will make a cut in the skin covering the break. This is to expose the bone fragments. The bone fragments will be moved into their normal position. Screws, a plate with screws, or a rod may be used to hold the bones in place. The doctor will close the incision with stitches. The area will be protected with a splint or cast and dressings.

Open Reduction of Tibia

Immediately After Procedure

The doctor will order another x-ray to ensure the bone is in the correct position.

How Long Will It Take?

This depends on the type and location of the fracture.

How Much Will It Hurt?

You will have pain after the procedure. Ask your doctor about medicine to help with the pain.

Average Hospital Stay

0-3 days (depending on the severity of the injury and your recovery)

Post-procedure Care

At Home

When you return home, do the following to help ensure a smooth recovery:

Rest your injured arm or leg on pillows. Elevate it above the level of your heart.
Gently move uninjured joints and toes.
Keep the cast, splint, and dressing clean and dry.
Wait until a "walking cast" is dry before walking on it.
Do not pull out the cast's padding. Do not break off any part of the cast.
Keep objects, dirt, and powder out of the cast.
Do not try to scratch under the cast.
Change the dressing as directed.
Be sure to follow your doctor’s instructions.

Small bones usually heal in 3-6 weeks. Long bones will take more time. Your doctor may have you work with a physical therapist. He can help you to regain normal function. In some cases, you may be able to return to daily activities within a few day while wearing the cast or splint.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Severe or unusual pain that is not relieved by pain medicine
Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Cough, shortness of breath, or chest pain
Numbness and/or tingling in the injured extremity
Loss of movement in the fingers or toes of the injured arm or leg
The cast feels too tight
Burning or stinging sensations under the cast
Redness of the skin around the cast
Persistent itching under the cast
Cracks or soft spots develop in the cast
Chalky white, blue, or black discoloration of fingers, toes, arm, or leg

In case of an emergency, CALL 911 .

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org/

American Orthopedic Society
http://www.sportsmed.org/tabs/Index.aspx/

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org/

Canadian Orthopaedic Foundation
http://www.canorth.org/

References:

American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/ . Accessed September 2, 2009.

Setting a broken bone without surgery (closed reduction). University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/aha/aha_clored_crs.htm . Updated January 2008. Accessed September 2, 2009.

¹10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2009;(4):CD003764.

Last reviewed November 2009 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.