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.