What are the methods of fracture repositioning?

(1) Manipulation. Most fractures can be corrected by manipulation of the displacement.

The manipulation must be done gently and should be done successfully. The steps of manipulation are as follows.

①Relieve pain. Local anesthesia, nerve block anesthesia or general anesthesia can be used, the latter is mostly used in children.

②Muscle relaxation position. After anesthesia, the joints of the affected limbs are placed in the muscle relaxation position to reduce the muscle pulling force on the fracture segment.

③Alignment direction. When the fracture is repositioned, the distal fracture segment is aligned with the direction indicated by the proximal fracture segment.

4) Extension traction. The distal end of the affected limb is pulled along its longitudinal axis under counter traction to correct the displacement of the fracture.

The operator touches the fracture site with both hands, and according to the type of fracture and displacement shown on the X-ray, the operator uses the techniques of reflexion, rotation, end lifting, pressing, and splitting of bones, wrenching, etc., to reset the fracture.

(2) Incisional reduction. The main indications for incisional reduction are: there are soft tissues such as muscle and tendon embedded between the fracture ends, and those who have failed in manipulative reduction; intra-articular fracture, poor alignment after manipulative reduction, which will affect the function of the joints; manipulative reduction fails to reach the standard of functional reduction, which will seriously affect the function of the affected limb; fracture is complicated with major vascular and nerve injuries, and it is advisable to carry out fracture incisional reduction at the same time of repairing the blood vessels and nerves; and multiple fracture is necessary to facilitate the care and treatment and prevent complications. For multiple fractures, in order to facilitate care and treatment, and to prevent complications, the appropriate site can be selected to carry out the incision and reduction.

Advantages and disadvantages of reduction. The most important advantage of incisional reduction is that it can make the fracture anatomically repositioned. Effective internal fixation allows the patient to get out of bed earlier and reduces myasthenia gravis or joint stiffness. It also facilitates care and reduces complications. Disadvantages are: may cause delayed healing or non-union of the fracture; increase the degree of local soft tissue injury, easy to occur infection; the use of improper internal fixation equipment, intraoperative difficulties may occur or affect the effect of fixation, aseptic inflammation can occur, the removal of internal fixation equipment, most of the need for another operation.