• Fracture Reduction—Open

    (Setting a Fracture)

    Definition

    This procedure is done to return a broken bone to its proper alignment. An open fracture reduction involves cutting through the skin to realign the bones. It is used if the bone is in many pieces or is difficult to reduce. Screws and a plate may be needed to hold the fragments in place.

    Reasons for Procedure

    Fracture reduction is done for the following reasons:
    • So that the bone can heal properly and more quickly
    • To decrease pain and prevent later deformity
    • To regain use of the bone and limb

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a fracture reduction, your doctor will review a list of possible complications, which may include:
    • Nerve damage
    • Infection
    • Bleeding
    • Fat particles from the bone marrow or blood clots from veins that may dislodge and travel to the lungs
    • Need for additional surgery if the bone does not heal properly
    • Reaction to anesthesia
    Factors that may increase the risk of complications include:
    • Advanced age
    • Pre-existing medical condition
    • An open fracture (broken bone is sticking out of skin)
    • Diabetes
    • Use of steroid medicine
    • Smoking
    Be sure to discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Your doctor will likely do the following:
    • Physical exam
    • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
    • Provide a splint for the broken bone to decrease the risk of additional injury
    Leading up to the procedure:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like warfarin (Coumadin)
      • Clopidogrel (Plavix)
    • You may need to take antibiotics, if advised by your doctor.
    • Arrange for a ride to and from the procedure. Also, arrange for help at home.
    • Eat a light meal the night before. Do not eat or drink anything after midnight.

    Anesthesia

    Your doctor may give you:
    • General anesthesia —blocks pain and keeps you asleep through the surgery
    • Local anesthesia—numbs the area; given as an injection (You may also be given a sedative.)

    Description of the Procedure

    The doctor will make a cut in the skin covering the break. This is to expose the bone fragments. The bone fragments will be moved into their normal position. Screws, a plate with screws, or a rod may be used to hold the bones in place. The doctor will close the incision with stitches. The area will be protected with a splint or cast and dressings.
    Open Reduction of Tibia
    Tibia repair
    Copyright © Nucleus Medical Media, Inc.

    Immediately After Procedure

    The doctor will order another x-ray to ensure the bone is in the correct position.

    How Long Will It Take?

    This depends on the type and location of the fracture.

    How Much Will It Hurt?

    You will have pain after the procedure. Ask your doctor about medicine to help with the pain.

    Average Hospital Stay

    0-3 days (depending on the severity of the injury and your recovery)

    Post-procedure Care

    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Rest your injured arm or leg on pillows. Elevate it above the level of your heart.
    • Gently move uninjured joints and toes.
    • Keep the cast, splint, and dressing clean and dry.
    • Wait until a "walking cast" is dry before walking on it.
    • Do not pull out the cast's padding. Do not break off any part of the cast.
    • Keep objects, dirt, and powder out of the cast.
    • Do not try to scratch under the cast.
    • Do not drive until told it is safe.
    • Change the dressing as directed.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor’s instructions.
    Small bones usually heal in 3-6 weeks. Long bones will take more time. Your doctor may have you work with a physical therapist. He can help you to regain normal function. In some cases, you may be able to return to daily activities within a few days while wearing the cast or splint.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Severe or unusual pain that is not relieved by pain medicine
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Cough, shortness of breath, or chest pain
    • Numbness and/or tingling in 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
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Orthopedic Society http://www.sportsmed.org/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/ . Accessed September 2, 2009.

    Setting a broken bone without surgery (closed reduction). University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/aha/aha%5Fclored%5Fcrs.htm . Updated January 2008. Accessed September 2, 2009.

    10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2009;(4):CD003764.

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