Definition

A procedure to position bone fragments in correct alignment. There are two types:

  • Closed reduction—The bone is set without making an incision in the skin.
  • Open reduction—This involves cutting through the skin to realign the bones.

Parts of the Body Involved

Bones

Reasons for Procedure

A reduction is done to return a broken bone to its proper alignment. This is done for the following reasons:

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

Risk Factors for Complications During the Procedure

  • Advanced age
  • Pre-existing medical condition
  • An open fracture (ie, wound through the skin to the bone)

What to Expect

Prior to Procedure

Your physician will likely do the following:

  • Physical exam
  • X-rays of the broken bone
  • Provide a splint for the broken bone to decrease the risk of additional injury

In the days prior to the procedure:

  • Arrange for a ride to and from the procedure.
  • Arrange for help at home after the procedure.
  • The night before, eat a light meal and do not eat or drink anything after midnight.

During Procedure

IV fluids, anesthesia, possibly a sedative

Anesthesia

For open reduction: general or local, possibly with a sedative

Description of the Procedure

A bone can be reduced using an open or closed method. The method of treatment depends on the type and location of the fracture and the location.

Open reduction: This method is used if the bone is fragmented or difficult to reduce and may require screws and a plate to hold the fragments in place. The doctor makes a cut in the skin covering the break to expose the bone fragments. The bone fragments are moved into their normal position, and screws, a plate with screws, or a rod may be used to hold the realigned bones in place. Extremely severe fractures may require placement of a natural or artificial bone graft. The doctor closes the incision with stitches, and a splint, dressings, plus a splint or cast may also be used to protect the area.

Open Reduction of Tibia

Tibia repair

© 2008 Nucleus Medical Art, Inc.

Closed reduction: The doctor manipulates the bone fragments into their normal position by applying traction and uses a cast or splint to hold them in place. There is no incision.

After Procedure

The doctor will immobilize the bone using a cast, splint, or brace, and he or she will probably order another x-ray to ensure the bone is in the correct position.

How Long Will It Take?

This depends upon the bone and the severity of the injury.

Will It Hurt?

Anesthesia prevents pain during the procedure. You may be given pain medication if you have pain during recovery.

Possible Complications

  • Fat particles from the bone marrow or blood clots from veins can dislodge and travel to the lung.
  • Anesthesia-related problems
  • Nerve damage causing loss of feeling
  • Need for additional surgery if the bone does not heal properly
  • Infection in the bone or bone marrow ( osteomyelitis )

Average Hospital Stay

Typically 0 to 3 days, depending on the seriousness of the break and how your recovery progresses. Sometimes more intensive physical rehabilitation is required.

Postoperative Care

  • Rest your injured arm or leg on pillows to elevate it above the level of your heart.
  • Gently move uninjured joints and toes.
  • Keep the cast, splint, and any dressings clean and dry.
  • Wait until a "walking cast" is completely dry before walking on it.
  • Do not pull out the cast's padding or break off any part of the cast.
  • Keep objects, dirt, and powder out of the cast.
  • Do not try to scratch under the cast.
  • Follow your doctor's instructions for dressing changes and pin care.
  • You may be given crutches or a sling.

Outcome

Small bones may heal in 3 to 6 weeks, but long bones will take more time. A specific activity and rehabilitation program may be recommended to speed your recovery and protect future function. Some patients may to go back to work or resume daily activities within a few days wearing a light cast or splint. Some may require more physical rehabilitation.

Call Your Doctor If Any of the Following Occurs

  • Severe or unusual pain that is not relieved by pain medication
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Shortness of breath
  • Numbness and/or tingling in the injured extremity or other parts of 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