Reduction

Reducing a fracture involves trying to return the bones to as near to their original position as possible (Fig. 21.9). Reduc­tion can be performed open, in which case the fracture is exposed surgically so that the fragments can be reduced under direct vision. If a fracture is reduced closed, then the accuracy of the reduction can only be checked on an X-ray. An advantage of closed reduction is that the soft tissues and blood supply should not be disrupted any further than occurred at the time of the trauma.

If a fracture is closed and can be reduced closed it should be. If it is already open, then the opportunity should be used when cleaning the wound to make sure that reduction is anatomical by performing an open reduction.

Emergency reduction

Emergency reduction should be undertaken immediately and without analgesia if the circulation or the skin of a limb is compromised (Fig. 21.10).