Reduction of fractures
Approach
- Describe fracture on X-ray (site, associated displacement, deviation, shortening)
- Initiation
- Same side of injury as patient
- Explain fracture, need for reduction
- Pain relief (NO, haematoma block)
- Assistance
- Counter-traction
- Traction
- Demonstrate traction - relax musculature around fracture site
- Reduction
- Reverse the dicetion in which the fragment is displaced at the time of injury
- May be necessary to increase angulatory deformity to disimpact the fracture
- Hold
- Held post reduction
- Place in backslab (as risk of swelling): stockinette, crepe, plaster
- Broad arm sling
Follow up
- Re-Xray
- Fracture clinic 2-3 days time: check reduction complete once swelling has improved
- X-ray 7-10 days as this is the most common time fracture redisplaces
- Information leaflet about care and complications of casts
- Would normally take 4-6 weeks to heal after which may need physiotherapy for any resulting stiffness
Colles Fracture
- Fracture of distal radius within 2.5cm of the wrist
- Commonest of all fractures (especially osteoporotic old women)
- Characteristic displacements
- Dorsal displacement
- Dorsal tilt
- Radial displacement
- Radial tilt
- Impaction
- Rotational deformity
- Disruption of ulnar styloid
Indications for reduction
- Displaced ulnar styloid (indicates serious disruption of inferior radioulnar joint)
- Dorsal tilt of 10' or more (except in old and frail)
