Reducing Fracture Deformity

The long-term purpose of reducing significant deformity associated with fractures is, of course, restoration of normal appearance and function of the extremity. However, there are also short-term reasons for reducing deformity early in the patient's course, including (1) alleviating pain, (2) relieving the tension on nerves or vessels that may be stretched as they pass over the deformity, (3) eliminating or significantly minimizing the possibility of inadvertently converting a closed fracture to an open one when the skin is tented by a sharp bony fragment, and (4) restoring circulation to a pulseless distal extremity.

After the patient has been sedated, deformity at or near the midshaft of a long bone is usually easy to reduce with gradual, steady longitudinal traction. Any rotational deformity should be corrected only after the angular component has been addressed and should be performed while traction is maintained. If reduction is performed as a definitive procedure prior to immobilization, attention to rotational deformity is particularly important because of its profound effect on ultimate function. As discussed earlier, rotational deformity is much easier to appreciate by examining the patient than by examining the x-ray.

The nearer the deformity is to a joint, the more difficult it may be to correct and the more specialized the reduction maneuver may have to be. Who performs the procedure, the emergency physician or the orthopedist, is determined by a variety of circumstances, some of which may be specific to the particular practice environment. When deformity is associated with circulatory deficit, a true emergency exists, and the anticipated delay until reduction should be considered.

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