Basic Principles of Reduction Maneuvers

Chapter 8 Basic Principles of Reduction Maneuvers



The three-point principle



1. Diaphyseal fractures (Figure 8-1, A):
a. The primary reductive force should be applied against the apex of the fracture.

b. Counterforce applied in the opposite direction both proximal and distal to the apex stabilizes the limb.

2. Metaphyseal/epiphyseal fractures (Figure 8-1, B):
a. The primary reductive force should be applied just distal to the fracture.

b. Counterforce should be applied in the opposite direction just proximal to the fracture and in the same direction as the primary force at the proximal end of the bone.

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Figure 8-1



Exaggerating the deformity



1. Indications for reduction by exaggerating the deformity:
a. Fully displaced fractures with an intact periosteal hinge (typically in children) and bayonet apposition (Figure 8-2)

b. Fracture fragments that will not disengage with traction and/or direct reduction maneuvers (Figure 8-3)

c. Rarely indicated for diaphyseal fractures

2. The principle of this reduction method is to:
a. Disengage the fracture fragments (Figure 8-4)

b. Allow direct reduction methods to succeed (Figure 8-5)

3. Technique:
a. Begin with manually applied traction and countertraction.

b. Place a thumb or two just proximal to the fracture on the side opposite the apex as a fulcrum.

c. Apply a point of counterforce proximal to the fracture on the side of the apex.

d. Exaggerate the deformity by accentuating the apex so that the angulation of the fracture exceeds 90 degrees.

e. Using the thumb(s), push distalward, moving the fulcrum more distal.

f. Correct the deformity and reduce the fracture.

image

Figure 8-2


image

Figure 8-3


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Figure 8-4


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Figure 8-5



The value of traction



1. Overcoming muscle force:
a. The skeleton counteracts the contractile forces of the muscles.

b. Muscles pulling against a broken bone will shorten it.

c. Fractures and muscle injury result in involuntary muscle spasm.

d. Traction allows the bone to be restored to its proper length by overcoming muscle contraction and spasm.

e. The amount of traction applied should exceed the amount of muscle spasm.

2. Disimpacting fractures:
a. Fracture fragments can become locked by interdigitating.

b. Distraction allows for reduction by translation.

3. Taking advantage of the soft tissue envelope:
a. Comminuted fractures can be reduced by hydrostatic pressure.

b. Intact tendons, muscles, and periosteum can directly reduce areas of comminution.

4. Applying traction:
a. Double digit construct:
(1) Make a loop of gauze with your left hand.

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Aug 24, 2016 | Posted by in ORTHOPEDIC | Comments Off on Basic Principles of Reduction Maneuvers

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