When a bone is broken, the fragments often shift out of their normal position, causing intense pain. The medical procedure to correct this misalignment is known as fracture reduction, or commonly, “resetting the bone.” While the manipulation required to bring the bone ends back together can be painful, modern orthopedic care uses sophisticated pain management techniques. These methods ensure that patients are comfortable and pain-free during the actual process of realigning the fracture, prioritizing successful healing.
The Process of Fracture Reduction
Fracture reduction restores the bone’s length and rotational alignment, allowing for proper healing. The method chosen depends on the fracture’s severity, location, and degree of displacement. Specialists typically choose between two main approaches to reposition the segments.
Closed Reduction
The less invasive method is closed reduction, which involves manually manipulating the bone fragments from outside the skin. This technique is often performed in an emergency setting for fractures that are not severely displaced. The doctor uses specialized pushing and pulling movements, known as traction and counter-traction, to guide the bone pieces back into anatomical position.
Open Reduction
A more complex injury, such as one with multiple fragments, may require an open reduction. This is a surgical procedure where an incision is made to directly visualize the fracture site. The surgeon physically repositions the fragments and often uses internal fixation, such as plates, screws, or rods, to hold them securely in place. Open reduction is chosen when closed manipulation is impossible or when the bone is too unstable to heal correctly.
Pain Control Methods Used During Reduction
Physical manipulation of fractured bone ends is inherently painful, so the procedure is never performed without significant pain control. The analgesic strategy is tailored to the type and complexity of the fracture reduction, aiming to completely block acute pain during the brief manipulation period.
Closed Reduction Pain Control
For closed reductions, two common techniques are procedural sedation and regional anesthesia. Procedural sedation uses intravenous medications like propofol or a combination of midazolam and fentanyl to induce deep relaxation and amnesia. This allows the patient to be responsive to simple commands but unaware of the manipulation. Regional anesthesia, which temporarily numbs a specific area, is also used. This involves administering a local anesthetic, such as lidocaine, near the nerves supplying the injured limb, effectively creating a nerve block. A common example is a hematoma block, where the anesthetic is injected directly into the blood clot surrounding the fracture site, numbing the bone ends before reduction begins.
Open Reduction Pain Control
Open reduction procedures require either general anesthesia or a major regional block, such as a spinal or epidural. General anesthesia ensures the patient is completely unconscious. A major regional block provides dense, long-lasting numbness to an entire limb.
Immediate Discomfort After the Bone is Set
While the reduction manipulation is painless due to procedural blocks, discomfort begins once the anesthesia starts to wear off. Throbbing pain is common as nerves “wake up” and blood flow returns, particularly within the first 12 to 24 hours. This initial pain is often related to post-reduction swelling of the soft tissues, which are now confined within a rigid cast or splint.
To manage this recovery pain, a multimodal approach uses several classes of medication to target different pain pathways. This starts with scheduled doses of non-opioid medications like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and mild pain. Opioids may be prescribed for short-term use to control breakthrough pain.
Patients are instructed to elevate the injured limb above heart level continuously for the first few days to minimize swelling. Applying ice packs to the outside of the cast or splint, as directed by a physician, also helps to reduce localized swelling and discomfort.
Consequences of Improper Bone Alignment
Fracture reduction prevents the severe long-term consequences of a bone healing incorrectly. When a fracture is left significantly misaligned, it can result in a complication known as malunion, where the bone heals in a crooked or twisted position. Malunion can permanently alter the biomechanics of the limb, leading to functional impairment, such as limited range of motion or joint instability.
If the bone fragments fail to heal together at all, the condition is termed a nonunion. Both malunion and nonunion lead to chronic pain, persistent weakness, and an increased risk of developing arthritis in adjacent joints. Correcting these long-term issues requires subsequent, more complex surgeries, such as an osteotomy to re-break and realign a malunited bone.