Fracture is a disease that often occurs in accidents. It will have many adverse effects on health and requires timely treatment. So what are the methods for fracture reduction? There are many methods of fracture reduction, and you need to choose according to the actual situation. Let’s learn more about the fracture reduction methods and what you need to pay attention to in fracture diseases.
1. Manual reduction
Manual reduction is the most common and widespread method of treating fractures, and it is also relatively the safest.
Note: After manual reduction, the shape and length of the patient's fracture site must be carefully checked to see if it has returned to normal.
Recommendation: After manual reduction and effective fixation, X-ray fluoroscopy or CT can be used to clarify the results of the reduction. If the reduction is poor, it can be corrected as needed.
2. Traction reduction
Traction reduction is both a method of reduction and the main measure of reduction. It is mainly used when manual reduction cannot be achieved. It can also be used after reduction. Unstable fractures.
3. Open reduction
Open reduction is an important reason why fractures cannot heal in a short time. It cannot be used casually. This method must be used according to the patient's indications and whether it is necessary. You can refer to the following indications for open reduction.
1. Fractures involving the articular surface, and manual reduction cannot achieve good alignment of the articular surface.
2. After a fracture, the muscles attached to the bone fragments contract, causing the bone fragments to shift and become difficult to align.
3. The scissoring force of the fracture end is high, the blood supply is poor, and the broken end of the bone needs strict fixation to heal, such as intracapsular fracture of the femoral neck.
4. There are soft tissues such as muscles, tendons, periosteum, nerves, etc. embedded between the broken ends of the fracture, and manual reduction fails.
5. There are multiple fractures on one bone and it is difficult to reduce them manually.
6. Those with unstable fractures of the long bone diaphysis, whose manual reduction is not satisfactory, and who are not suitable for treatment with traction methods, but internal fixation has a better effect.
7. If the fracture is accompanied by rupture of the main blood vessels of the limb, the bone scaffold should be reconstructed first during treatment, such as partial or complete limb disconnection.
8. The fracture is not connected or malunion occurs, and the functional recovery is poor.
4. Reduction method of touching the heart with hands
To touch the heart with hands is a necessary step before performing the technique, so as to align the displacement direction of the fracture end shown on the X-ray film with the patient's limbs. Combined with the actual situation, an image of fracture displacement is formed in the surgeon's mind. Before restoration, the fracture must be touched with hands.
Method: When touching, first light and then heavy, from shallow to deep, from far to near, with both ends facing each other, confirm the position of the touching end in the body, and achieve "knowing its body shape and its location. The purpose of clinical realization is that the machine touches the outside, the skill arises from the inside, the hand turns according to the heart, and the dharma comes out of the hand."
5. Pull-out and traction method
The pull-out and traction method is mainly to overcome muscle tension, correct overlapping displacement, and restore limb length. According to the principle of "separate first if you want to get together, then get back together after separation".
Method: When starting traction, keep the limb in its original position first, along the longitudinal axis of the limb, resist traction from the near and far fracture segments, and slowly pull out the broken end of the fracture that penetrates into the soft tissue around the fracture. Stretch out, and the traction force is based on the strength of the patient's muscles.
Note: Children, the elderly and female patients should not use too much traction force. On the contrary, young and middle-aged male patients with well-developed muscles need to use strong force. For affected limbs with rich muscle groups, such as the femoral shaft, bone traction should be combined to help correct overlapping displacement. For humeral shaft fractures, although the muscles are relatively developed, overlapping displacement is easier to correct under anesthesia. If the force is slightly greater, the broken ends may easily separate. The pulling-out method can create conditions for the next operation, and it is still necessary to perform other operations. Maintain a certain pulling and stretching force until the plaster is properly applied before stopping.
6. Placement and rewinding method
Purpose: The placement and recirculation method is mainly to correct the rotation and dorsal displacement between the fracture ends. The rotation technique is used during the traction process, with the distal end For the proximal end, the axis of the bone is aligned accordingly, and the rotational deformity is corrected by itself.
Indications: The wraparound maneuver is mostly used for femoral shaft or humeral shaft fractures where soft tissue is embedded between the broken ends of the bone;
Method: During the maneuver, traction should be increased first to separate the fractured ends. , the embedded soft tissue can often be freed on its own; then the traction is released, and the surgeon holds the distal and proximal fracture segments with both hands, recirculates them in the opposite direction according to the original fracture displacement direction, and guides the fracture ends to face each other, so that the fracture ends can touch each other. The absence and strength of the embedded soft tissue are used to determine whether the embedded soft tissue is completely freed. For back-to-back displaced fractures, the direction of the rewinding technique is the opposite direction of the fracture displacement, which can often bring the back-to-back fracture ends to face each other.
7. Flexion-extension-retraction method
Purpose: The flexion-extension-retraction method is mainly used to correct the angular deformity between the fracture ends. Fractures close to the joint are prone to angular deformity because the short fracture segment near the joint is pulled too tightly by muscles in one direction.
Indications: Extension-type supracondylar humerus fractures require flexion under traction; while flexion-type supracondylar fractures of the femur require extension under traction. Extension-type supracondylar femoral fractures can be treated with tibial tubercle needles. Knee joint flexion and traction; while the flexion type requires inserting a needle on the femoral condyle to perform traction on the knee joint in the extended position, so that the fracture can be aligned. For fractures near multi-axial joints (such as shoulder and hip joints), there are generally three For fractures that are displaced in three planes (horizontal plane, transverse plane, coronal plane), several directions must be changed during reduction to restore the fracture. For example, for an adducted humeral surgical neck fracture, the patient is in the supine position and the direction of traction is It involves first adducting and then abducting, then bending forward and over the top, and finally internally rotating and tapping the fractured end, and then slowly lowering the affected limb to correct its insertion, overlap, rotational displacement, and inward, outward, and outward movements. Anterior angular deformity.
Note: Not only cannot the deformity be corrected by traction alone for this type of fracture, the greater the traction force, the greater the angle. For fractures near uniaxial joints (elbows, knees), the angle can only be corrected by pulling the distal fracture segment together with the distal limb of the joint that forms an integral part of it in the direction pointed by the proximal fracture segment. .
8. Angled roofing method
Indications: When patients with transverse or zigzag fractures in muscular patients cannot completely correct their overlapping displacement by traction alone, folding roofing can be used instead. Technique.
Method: This is a relatively labor-saving method. When folding the roof, the surgeon presses the thumbs of both hands on one end of the protruding fracture, overlaps the other four fingers and encircles the other end of the sunken fracture, and presses the thumbs of both hands toward the protruding fracture. Squeeze the protruding fracture end downward to increase the original angle of the fracture end. Relying on the feeling of your thumb, it is estimated that the bone cortex of the far and near ends of the fracture has been connected to the top, and then suddenly reflexed. At this time, the bone surrounding the other end of the fracture The four fingers continue to lift the sunken fracture end upward, while the thumb still presses the protruding bone end downward with force, forming a twisting force (shearing force) between the thumb and its four fingers.
Note: The amount of force depends on the original overlap and displacement, and the direction of force can be positive or oblique. Those with simple front and rear overlapping displacement can have their roof folded forward, while those with lateral displacement can have their roof folded diagonally. Through this method, not only the overlapping displacement can be corrected, but the lateral displacement can also be corrected at the same time. For fractures in the middle and lower 1/3 of the forearm, bone splitting and roof folding techniques are generally used to obtain a successful reduction.
9. End-squeezing and lifting method
Method: After overlapping, rotation, and angular deformities are corrected, lateral displacement becomes the main deformity of the fracture. For lateral displacement, you can use your thumb to apply direct force on the broken end of the fracture to force it into position, with the central axis of the human body as the boundary. For medial and lateral displacement (i.e., left and right displacement), use end-squeezing techniques, and for anterior and posterior displacement ( That is, up and down shifting) using the lifting and pressing technique. During the operation, use one hand to fix the proximal end of the fracture, and the other hand to hold the distal or outer end of the fracture and squeeze inward or lift up and down.
Note: The position must be accurate, the force must be appropriate, and the focus point must be stable.
10. Squeezing bone separation method
Any fracture where two bones are juxtaposed, such as radius and ulna, tibia and fibula fractures, etc., the fracture segments will be close to each other due to the contraction of the interosseous membrane, and the entire bone will be broken. When recovering, use the thumbs of both hands as one side, and the index, middle, and ring fingers as the other side. Squeeze the bone gap at the fractured part to separate the close fractured ends. The far and near fractured segments are each stable. Double fractures can be viewed side by side. Single fractures can also be repaired.
11. Swinging touch method
After the above techniques, the general fracture can be basically restored, but there may still be a crack between the ends of the transverse or zigzag fracture. Use the swinging touch method. The touching method can bring the fracture surfaces into close contact. The surgeon uses both hands to fix the fracture, and the assistant gently swings the distal end of the fracture left and right or up and down while maintaining traction, so that the bone fricative becomes smaller until it disappears.
The fracture surface can be closely matched. When the transverse fracture occurs at the junction of loose metaphysis and solid bone, after the fracture is repaired and fixed, you can use one hand to position the splint at the fracture site and gently tap the distal end of the fracture with the other hand to The fractured sections are tightly intercalated, making the restoration more stable.
12. Notes on contraindications for fractures
1 Taboo: Eat more bones
Some people believe that you should eat more bones after a fracture, so that the fracture can heal early. In fact, this is not the case. Modern medicine has proven that if patients with fractures eat more bones, not only will they not be able to heal early, but they will actually delay the healing time of the fractures. Because the regeneration of damaged bones mainly relies on the function of bone marrow and periosteum, and bone marrow and periosteum can only function better under the condition of increasing collagen, and the main components of meat bones are calcium and phosphorus.
If you eat too many ribs and drink bone soup after a fracture, it will increase the inorganic content of the bone and lead to an imbalance in the proportion of organic matter in the bone. Therefore, it will hinder the early healing of fractures. However, fresh pork ribs and meat bone soup are delicious and can stimulate appetite, so patients with fractures can eat less.
2. Don’t: Supplement more calcium
Calcium is an important raw material for forming bones. Some people think that supplementing more calcium after a fracture can speed up the healing of the broken bone. But in fact, this is a misunderstanding that most people have. Fractures are not osteoporosis, and patients with fractures do not lack calcium. Of course, even if they have osteoporosis, they cannot supplement calcium randomly. Moreover, increasing calcium intake does not speed up the healing of broken bones. For fracture patients who have been bedridden for a long time, there is a potential risk of causing an increase in blood calcium.
For patients with fractures, there is no lack of calcium in the body. As long as they strengthen functional exercises and move as early as possible according to the condition and the doctor's instructions, they can promote the absorption and utilization of calcium by the bones and accelerate the bone growth. During healing, especially for patients who are bedridden after fracture, blind calcium supplementation may be harmful.
3 Don’ts: Drink less water
Bed-ridden patients with fractures, especially those with fractures of the spine, pelvis and lower limbs, have difficulty moving, so they should drink as little water as possible to reduce urination. number of times. Although the frequency of urination is reduced, bigger troubles arise. For example, bedridden patients have less activity, weakened intestinal motility, and reduced drinking water, which can easily cause constipation. Long-term bedridden and urinary retention can also easily induce urinary tract stones. and urinary tract infections. Therefore, bedridden fracture patients must not drink less water.