Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Principles of fracture reduction and fixation
What it is
Reduction means putting the fracture pieces back in place, and fixation means holding them there. Open reduction is to open at the fracture site, see the fracture pieces with the naked eye, return them and fix them. Closed reduction does not cut the skin: it is manipulation alone, moving the limb to bring the pieces back.
How it is diagnosed
When you are given an x-ray, look for displacement, meaning the fracture pieces are not joining together so the bone is not a straight line, for shortening, meaning an overlap between the bones, and for angulation and rotation. If none of these is present there is no need for reduction, and it is enough to hold the position of the limb until it heals. If any of them is present, move to reduction. Open fractures have their own scheme, the Gustilo classification. Type I is an open fracture with a skin wound under 1 cm in length and clean. Type II is an open fracture with a laceration over 1 cm in length without extensive soft tissue damage, flaps or avulsions. Type III is an open segmental fracture with a wound over 10 cm with extensive soft tissue injury or a traumatic amputation, and gunshot fractures and open fractures caused by farm injuries are special categories within it. Type III is then split three ways. IIIA is adequate soft tissue coverage. IIIB is significant soft tissue loss with exposed bone that requires a soft tissue transfer to achieve coverage. IIIC is an associated vascular injury that requires repair for limb preservation, in which the peripheral artery pulse is absent.