A closed reduction is a non-surgical procedure used by healthcare professionals to realign the fragments of a broken bone. This process is often performed in an emergency department or orthopedic clinic to restore the bone’s normal anatomical alignment without making an incision into the skin. The term “closed” refers to the fact that the skin remains intact, distinguishing it from an open reduction, which requires surgery and direct visualization of the fracture site. By gently manipulating the limb, the provider moves the bone fragments back into position, allowing the bone to heal with better structure and function. This less invasive approach generally leads to a lower risk of infection and a faster recovery time compared to surgical repair.
When Closed Reduction is the Right Choice
The decision to proceed with a closed reduction depends primarily on the nature and stability of the fracture. This technique is reserved for closed fractures, where the broken bone has not punctured the skin, preventing contamination. Fractures that are minimally displaced or shortened, where the fragments are still relatively close to their correct position, are excellent candidates for this procedure. The approach aims to correct angulation or rotation that could impair proper healing and function of the limb.
A closed reduction is not suitable for highly unstable or severely comminuted fractures, which involve multiple bone fragments difficult to hold in place without surgical hardware. Any open or compound fracture, where the bone has broken through the skin, requires an open reduction because the wound must be surgically cleaned to prevent deep bone infection. If soft tissue, such as muscle or tendon, becomes lodged between the fragments, surgery is often needed to remove the obstruction before the bone can be properly set.
Performing the Alignment: Anesthesia and Technique
Because realigning a broken bone can be painful, effective pain management is necessary before the manipulation begins. The level of pain control varies depending on the fracture’s location and complexity, ranging from a local anesthetic or nerve block to moderate sedation. A local block involves injecting numbing medication near the fracture site or the nerves supplying the area. Sedation uses intravenous medication to make the patient relaxed and comfortable, often without being fully asleep. For more complex or painful fractures, or in children, general anesthesia may be used to ensure the patient is completely unconscious and the muscles are fully relaxed.
The physical technique centers on the principle of traction and counter-traction, which is the controlled application of opposing forces to stretch the limb and disengage the fragments. Traction involves pulling along the long axis of the injured limb to overcome muscle spasm and re-lengthen the bone. Simultaneously, a counter-traction force is applied to stabilize the body part above the fracture, often by a second clinician or a specialized brace. This carefully applied force creates space between the bone ends, allowing the professional to gently correct any rotation or angulation by manipulating the fragments back into anatomical alignment.
Immediate Steps After the Bone is Set
Once the bone fragments are in the correct position, the immediate step is to confirm the alignment through medical imaging. This typically involves using fluoroscopy, which provides a real-time X-ray image, or a standard X-ray taken immediately after the manipulation. Confirmation ensures the achieved reduction is satisfactory and the bone ends are positioned correctly to support the limb’s future function. If the images show the alignment is not adequate, the reduction procedure may need to be repeated.
After successful alignment, stabilization is immediately required to maintain the reduction and prevent the bone from slipping back out of place. This is achieved by applying a rigid cast or a splint, which immobilizes the joint above and below the fracture site. The cast or splint acts as an external support structure, holding the bones firmly while the natural healing process begins. Following immobilization, neurovascular checks are performed to assess the circulation and nerve function in the limb, including sensation, movement, and pulse in the fingers or toes. The patient is then managed for pain and instructed to elevate the limb above heart level to control swelling.