Indications for reduction

If a fracture is allowed to heal in a displaced position the fracture will unite, but it may go on to malunion. This may be unacceptable either because it is ugly (deformity) or because it interferes with the function of the limb. Malunion is not usually painful.

Remodelling in children

Fractures in children remodel as the skeleton grows. Some deformity can therefore be accepted because this will correct itself over the following months. Grade 2 epiphyseal fractures in children are easy to reduce but may then slip back out of a satisfactory position. Re-reduction carries a risk of causing growth plate damage (especially if it is performed more than 2 or 3 days after the fracture). Under these circumstances it may be better to accept the malunion resulting from a slip rather than risk an epiphyseal arrest while trying to produce a perfect reduction.

Stable impacted fractures

If the fracture is stable and impacted then it will heal quickly with a minimum need for protection. Disimpaction (separation of the fragments) and reduction will automatically make the fracture unstable. The fracture will then need more sophisticated methods for holding it. In the elderly, a rapid return to independent existence may be more important than cosmesis. A stable distal radius (Colles) fracture in an

elderly patient who is only just managing to cope with independent existence may be best left unreduced and managed in a removable splint for comfort. Within 2 weeks it will be almost painless and can be used for everyday activities. Reduction would require a plaster for at least 4 weeks, during which time bathing and cooking might prove impossible.