Closed Reduction Principles
•All displaced fractures should be reduced to
minimize soft tissue complications, including
those that require ORIF
•Use splints initially
–Pad all bony prominences
–Allow for swelling
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Closed Reduction Principles - Orthopaedic Trauma - Lecture Slides, Slides of Orthopedics
Closed Reduction Principles, Bony Prominences, Muscle Relaxation, Reduction Maneuver, Longitudional Traction, Anesthesia for Closed Reduction, Hematoma Block, Deep Conscious Sedation are some points from this lecture. This lecture is for Orthopaedics Trauma course. This lecture is part of a complete lectures series on the course you can find in my uploaded files.
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2011/2012
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Closed Reduction Principles
- All displaced fractures should be reduced to minimize soft tissue complications, including those that require ORIF
- Use splints initially
- Pad all bony prominences
- Allow for swelling
Closed Reduction Principles
- Adequate analgesia and muscle relaxation are critical for success
- Reduction maneuver may be specific for fracture location and pattern
- Correct/restore length, rotation, and angulation
- Immobilize joint above and below
Closed Reduction Principles
- Longitudional traction may not allow the fragments to be disimpacted and brought out to length if there is an intact soft-tissue hinge (typically seen in fractures of the distal radius and ulna in children)
Figure from Chapman’s Orthopaedic Surgery 3(Redrawn from Charnley J. The Closed Treatment ofrd^ Ed. Common Fractures, 3rd ed. Baltimore: Williams &Wilkins, 1963.)
Closed Reduction Principles
- Reproduction of the mechanism of fracture to hook on the ends of the fracture
- Angulation beyond 90° is usually required
Figure from Chapman’s Orthopaedic Surgery 3(Redrawn from Charnley J. The Closed Treatment ofrd^ Ed. Common Fractures, 3rd ed. Baltimore: Williams &Wilkins, 1963.)
Anesthesia for Closed Reduction
- Hematoma Block - aspirate hematoma and place 10cc of Lidocaine at fracture site - Less reliable than other methods - Fast and easy - Theoretically converts closed fracture to open fracture but no documented increase in infection
Anesthesia for Closed Reduction
IV Sedation
- Versed - 0.5 – 1 mg q 3 minutes up to 5mg
- Morphine - 0.1 mg/kg
- Demerol - 1- 2 mg/kg up to 150 mg
- Beware of pulmonary complications with deep conscious sedation - consider anesthesia service assistance if there is concern
- Pulse oximeter and careful monitoring are recommended
Common Closed Reductions
Distal Radius
- Longitudinal traction
- Local or regional block
- Exaggerate deformity
- Push for length and reversal of deformity
- Apply splint or cast with 3-point mold
Figure from: Rockwood and Green: Fractures inAdults, 4th (^) ed, Lippincott, 1996. Docsity.com
Common Closed Reductions
- Elbow Dislocation - traction, flexion, and direct manual push
Figures from Rockwood and Green, 5th^ ed. Docsity.com
Common Closed Reductions
Hip Dislocation
- Relaxation, flexion, traction, and rotation
- Gentle and atraumatic
Relocation should be palpable and permit significantly improved ROM. This often requires very deep sedation. Figures from Rockwood and Green, 5th ed. Docsity.com