A fracture is a break in a bone. A displaced fracture occurs where the broken bone ends have shifted significantly out of their normal anatomical position. The misalignment prevents the bone from healing correctly, which can lead to long-term physical problems. Medical intervention is necessary to restore the normal shape and position of the fractured bone fragments to ensure the bone can heal with the correct structure and function.
The Specific Terminology for Fracture Reduction
The medical term for restoring the bone fragments to their correct alignment is reduction. Reduction minimizes the gap and displacement at the fracture site. Restoring proper alignment must be completed before the healing process can begin effectively.
Another common term is setting the bone. Reduction procedures are broadly categorized into two main types: closed reduction and open reduction. These terms describe the physical approach used to realign the bone, whether through external pressure or surgical means.
Methods of Aligning the Bone
Physicians choose between two primary methods, depending on the fracture’s severity, stability, and location. The less invasive technique is the closed reduction, which involves physically manipulating the broken bone fragments from outside the body without making a surgical incision. This technique requires the physician to use manual techniques and sometimes traction to realign the bone.
Because the procedure can be painful, the patient is typically given pain medication, a nerve block, or conscious sedation to ensure comfort and muscle relaxation. After the fragments are successfully realigned, the limb is stabilized, and an X-ray is immediately taken to confirm the bone is in the correct position. Closed reduction is typically used for less severe or simpler fractures, where the skin remains intact.
For more complex or unstable injuries, the physician must perform an open reduction, which is a surgical procedure. This involves making an incision to directly visualize the fracture site and use instruments to realign the bone fragments. Open reduction is often necessary when the fracture is severely displaced, involves a joint surface, or has multiple fragments. Following the alignment, the bone fragments are typically held in place using specialized medical hardware such as plates, screws, pins, or rods; this combination is known as open reduction internal fixation, or ORIF.
Why Fracture Reduction is Essential
Proper fracture reduction is necessary for the bone to heal with its intended strength and function. If a displaced fracture is left unreduced, the bone fragments will heal in their misaligned position, a complication known as malunion. This can lead to a visible deformity of the limb and may cause significant long-term functional impairment. Malunion can result in chronic pain, limited range of motion in nearby joints, and persistent disability.
An unreduced, sharp bone fragment can pose an immediate risk to surrounding soft tissues. Displaced ends of the bone can press on or damage adjacent nerves and blood vessels, potentially leading to numbness, circulation problems, or permanent tissue damage. Reduction alleviates the tension on these soft tissues and helps restore the correct blood flow, which is necessary for proper bone healing. Without correct stabilization and alignment, the fracture may fail to heal entirely, a condition called nonunion, which often requires further surgery.
Immediate Steps After Bone Alignment
Once the bone fragments are successfully aligned, the next immediate step is to ensure the bone remains stable. This stability is primarily achieved through immobilization, which involves applying a cast, splint, or brace to the injured limb. The immobilization device holds the bone in the corrected position, preventing any movement that could disrupt the healing process.
Following the procedure, a final X-ray is always performed to confirm the anatomical alignment of the bone fragments has been maintained. Initial pain management is also a significant concern, and patients are typically prescribed medication to manage discomfort. Patients are usually advised to keep the injured limb elevated above the heart level and apply ice to the area to help control swelling and pain in the first few days.