The best time for fracture reduction

Fracture patients need manual reduction treatment, so when is the best time for fracture reduction? The answer is of course the sooner the better. This is because when a fracture occurs, the fracture site has not become more swollen and it is easier to perform manual reduction. In addition, the following will introduce to you in detail some of the relevant requirements for manual reduction, preparations before reduction, and specific contents of the reduction standards.

1. Requirements for manual reduction

Bone-setting manipulation is a basic method for treating fractures and occupies a very important position in orthopedics. Most fractures can achieve satisfactory results through bone-setting manipulation. The hand-closed operation should be steady, accurate and light.

2. Preparation before hand repositioning

(1) Preparation of the surgeon and assistant: The surgeon and assistant need to have a comprehensive understanding of the patient's systemic and local conditions and make a diagnosis based on the patient's medical history, injury mechanism, clinical examination results, and X-rays. Clearly diagnose the location, displacement direction and type of fracture. Analyze and formulate the methods, steps, responsibilities, and fixing equipment for manual reduction. Try to complete the manual reduction in one go.

(2) Anesthesia: Manual reduction uses anesthesia to relieve pain, relax the muscles, facilitate reduction, and avoid shock caused by pain. Generally, local intrahematoma anesthesia can be used, and nerve block anesthesia can also be used if the reduction time is long. For simple fractures, if the operator is skilled and confident that satisfactory reduction can be achieved in a short time, anesthesia is not necessary.

3. Time for manual reset

In principle, the earlier the manual reduction is performed, the better. It is generally believed that within 2 hours after injury, local swelling is lighter, muscles have not yet spasmed, reduction is easier, and reduction is most suitable. Children can achieve satisfactory results within 5 days after injury, and adults can still consider manual reduction after 7-10 days. For patients with severe swelling of the injured limb, temporary fixation or skin traction can be performed to elevate the affected limb, and then reduction can be performed as soon as possible after the swelling is reduced. Children's fractures heal faster and should be reduced earlier. However, severely swollen supracondylar humeral fractures and proximal tibia fractures should be reduced as soon as possible to relieve pressure on blood vessels and reduce bleeding. Open fractures should be reduced during debridement.

4. Standards for manual reduction

(1) Anatomical reduction: The ideal reduction is when the fracture displacement is completely corrected, the normal anatomical relationship of the bones is restored, and the position and alignment are completely good. It is easy to exercise early, heals quickly, meets physiological requirements after healing, and has good functional recovery.

(2) Functional reduction: Although every effort is made during fracture reduction, some displacement is still not completely corrected. However, after the fracture heals in this position, there is no obvious effect on limb function.