From the Research
Open reduction of a fractured bone is a surgical procedure performed with the objectives of restoring normal alignment and providing stability to broken bone fragments after a fracture. This technique allows the surgeon to manually manipulate and realign the fractured pieces into their proper anatomical position. Once the bone fragments are correctly positioned, they are typically held in place with internal fixation devices such as metal plates, screws, rods, or pins.
Key Points
- The procedure is necessary when closed reduction (manipulation without surgery) cannot achieve proper alignment, when the fracture is displaced or complex, or when the bone fragments have damaged surrounding tissues.
- Open reduction provides better visualization of the fracture site, allowing for more accurate realignment and stable fixation, which promotes proper healing.
- The procedure is performed under general or regional anesthesia, and patients typically require a period of immobilization and physical therapy afterward to regain strength and function.
- Potential risks include infection, bleeding, damage to surrounding structures, and complications related to anesthesia.
Evidence
The most recent and highest quality study on this topic is from 2022, which presents the design and preliminary testing of a multi-degree-of-freedom device capable of performing both distraction and reduction of fractured bone fragments using a traction splint mechanism with locking ball joints 1. This study found that the device reduced the maximum force required to create needed traction by 80%, and was more intuitive and less obstructive than existing techniques.
Considerations
While other studies have reported on the outcomes of open reduction and internal fixation for various types of fractures, including calcaneal fractures 2, 3, 4, 5, the 2022 study provides the most recent and highest quality evidence on the purpose of open reduction of a fractured bone.
Recommendation
Based on the strongest and most recent evidence, open reduction of a fractured bone is recommended when closed reduction cannot achieve proper alignment, or when the fracture is displaced or complex. This procedure provides better visualization of the fracture site, allowing for more accurate realignment and stable fixation, which promotes proper healing and reduces the risk of complications.