Treatment of fractures - closed reduction - Closed comparison of bones

The SANMEDEXPERT clinic treats all types of injuries to the musculoskeletal system, including closed fractures.

A closed fracture is a bone injury that breaks its integrity without damaging the skin over the injury site. Closed fractures are much more common than open ones. Often they are not detected immediately, hiding behind soft tissue swelling, especially if the injury is not accompanied by displacement of bone fragments. A closed fracture of the ribs with displacement is very dangerous - the sharp ends of their fragments cause damage to the chest organs (primarily the lungs and large vessels) even leading to death.

Possible complications of closed bone reduction

Complications are rare, but no procedure is guaranteed to be risk-free. If you plan to repair a broken bone, you need to be aware of possible complications, which may include:

• Nerve damage;
• Pieces of tissue from the bone marrow or blood clots from a vein can travel to the lungs;
• The need for surgery if the bone does not heal;
• Reaction to anesthesia.

Factors that may increase the risk of complications:

• Advanced age;
• Open fracture;
• Existing diseases;
• Diabetes;
• Steroid use;
• Smoking.

You should discuss these risks with your doctor before the procedure.

Kinds

Osteosynthesis of hand bones can be performed in two ways:

• Submersible - in this case, metal elements come into contact with bone fragments and fix them directly in the fracture zone.
• External – variations on the Ilizarov, Obukhov, etc. apparatus can be used to fix bone fragments. There is no direct effect on the bone.

In turn, for immersion osteosynthesis, the generally accepted classification is based on the method of localization of the metal structure: intraosseous and onlay.

How is closed bone reduction performed?

Preparation for the procedure

Your doctor will likely do or prescribe the following:

• Physical examination;
• X-ray is a test that uses radiation to take pictures of structures in the body, especially bones;
• Splint the broken bone to reduce the risk of additional injury.

Before the procedure:

• For open fractures, antibiotics may be prescribed;
• You need to arrange travel to and from the procedure. Also, consider in-home help;
• The evening before the procedure, you can eat a light meal. Don't eat or drink after midnight.

Anesthesia

The doctor will usually provide local anesthesia to numb the procedure area. The anesthetic is given by injection. You may also be given a sedative.

In some cases, general anesthesia will be used. You will sleep during the procedure.

Description of the closed bone reduction procedure

The bone fragments will be restored to their normal position. The doctor will apply a plaster cast or splint to hold the bones in place. The procedure is performed without incisions to the skin or tissue.

Immediately after the procedure

The doctor will order an x-ray to make sure the bone is in the correct position.

Indications for osteosynthesis of hand bones

• A fracture that heals very slowly during standard therapeutic treatment.
• A fracture resulting in damage to the joint tissue.
• Fractures with displacement and divergence of bone fragments.
• A fracture in which there is a possibility of displacement, divergence of bone fragments or perforation of the skin.
• A fracture that has not healed properly.
• Presence of false joints.

In practice, osteosynthesis can be used for fractures of any bones:

• In maxillofacial surgery to correct facial deformities
• For fractures of the lower bones of the lower extremities and the hip joint (thigh, tibia, ankle)
• For fractures of the upper extremities (radius, humerus, forearm)
• In microsurgery, for example, osteosynthesis of hand bones (wrist, finger phalanges)

Care after closed bone reduction

Home care

When you return home, follow these steps to ensure a normal recovery:

• Place your injured arm or legs on a pillow. Raise them above heart level;
• Gently move the intact joints of your arms and legs;
• Keep your cast, splint, and bandage clean and dry;
• Wait until the cast has completely hardened before placing weight on the injured limb;
• Do not try to scratch under the cast;
• Do not drive until your doctor says it is safe to do so;
• Ask your doctor when it is safe to shower, swim, or expose the incision site to water;
• Be sure to follow your doctor's directions.

Small bones usually heal in 3-6 weeks. Larger bones will take longer to heal.

Your doctor may prescribe work with a physical therapist. It will help restore normal functioning of damaged body parts or limbs. In some cases, you may be able to return to your daily activities within a few days despite the cast or splint being applied.

Why surgery is needed

If reduction is not carried out in a timely manner, serious complications may arise. The most common of them is a deviated nasal septum, which causes:

• disturbances of normal nasal breathing;
• constant inflammation of the mucous membrane and paranasal sinuses (chronic rhinitis, sinusitis);
• disorder of smell perception, up to complete anosmia.

Another common complication is a hematoma of the nasal septum, which in turn leads to narrowing of the nasal canals, difficulty breathing, and in some cases, suppuration or melting of the cartilage.

You need to understand that not a single untreated fracture goes away without a trace. Timely reposition allows not only to avoid such problems, but also to do without subsequent plastic surgery. The intervention lasts only a few minutes, does not require hospitalization, and postoperative recovery is about 2 weeks.

Contacting your doctor after closed bone reduction

After returning home, you should consult a doctor if the following symptoms appear:

• Severe or unusual pain that does not go away after taking pain medications;
• Signs of infection, including fever and chills;
• cough, shortness of breath, or chest pain;
• Numbness and/or tingling in the injured limb;
• loss of movement in the fingers or toes or in the injured arm or leg;
• A burning or tingling sensation under the cast;
• Redness of the skin around the cast;
• Constant itching under the cast;
• Cracks or stains in the cast;
• Chalky white, blue or black color of fingers and toes.

Symptoms of a fracture

All symptoms of a closed fracture can be divided into absolute and relative.

The following are considered absolute characteristics:

• unnatural mobility in the damaged area;
• deformation of the limb, which may be absent if there is no displacement of bone fragments;
• crepitus (crunching sensation when palpating the site of injury).

Relative features are:

• pain that can cause painful shock;
• limitation of limb mobility;
• increasing swelling;
• hematoma.

Diagnosis of a closed fracture

A closed fracture is more difficult to diagnose compared to an open one. The main research method is radiography in two or more projections including at least one joint. In addition, the following are used:

• computed tomography to study the condition of bone structures;
• magnetic resonance imaging to study soft tissues;
• arthroscopy and ultrasound to study intra-articular injuries.

To assess the severity of the condition, it may be necessary to consult a neurologist or neurosurgeon, an abdominal surgeon (if the pelvic bones are damaged), or a vascular surgeon. All these difficult diagnostic stages are available in modern medical science.

First aid

Independent attempts to reduce bone fragments are unacceptable. This threatens the occurrence of painful shock, dangerous additional injury to surrounding tissues and increased blood loss. The correct algorithm of actions is as follows:

1. Give a pain reliever.
2. Immobilize with reliable fixation - not only the injured area, but also the two joints on the sides of the injury site. Fixation of a leg fracture is carried out using a special splint, a light board or a straight stick. The arm is fixed with a special orthosis, a scarf made of thick fabric or a bandage, which is secured to the neck. If the spine is damaged, the victim is placed on a hard, flat surface.
3. Call an ambulance or independently, without disturbing the immobility of the damaged area, deliver the victim to a medical facility.

Prices for surgery

Indications

Osteosynthesis is performed on patients in the following cases:

• Fractures with fragments in which closed reduction is impossible.
• Fractures that do not heal for a long time.
• Clinical pictures of fractures in which there is a risk of perforation by a bone fragment of the skin or damage to surrounding tissues and organs.
• Valgus deformity against the background of bone fusion after a fracture.
• Flat feet.

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Bone repositioning in St. Petersburg

Fractures occur very frequently in humans, and many are displaced. This is due to the fast pace of life, a large number of accidents, and children’s failure to comply with safety rules. The most common, but also banal reason is a fall in winter, due to a slippery road or sidewalk, or icy conditions.

Reduction is necessary for closed and open displaced fractures. Bone repositioning allows you to assemble bone fragments into a single whole for better fusion and subsequent proper functioning of the limb.

There are two types of reposition:

• closed - the skin remains intact;
• open - the place is exposed for a more thorough comparison of fragments and ends with fixation.

Our clinic offers bone repositioning procedures, which are performed by real professionals. Our doctors have extensive experience in the effective treatment of fractures of any complexity, including multiple displacements. If you suspect signs of bone displacement in yourself or your relatives or children, contact us immediately. The sooner help is provided, the better!

Signs of bone displacement

• deformation, unnatural bend and appearance of the limb;
• pain (although many patients may not initially feel pain due to shock);
• increasing swelling;
• restriction of mobility or its appearance where it should not be.

The need for urgent medical care is justified by the fact that complications quickly appear in the form of necrosis (death of soft tissue), paralysis, and edema.

How does the procedure work?

We carry out the procedure after a complete X-ray examination, under local or general anesthesia. After the bone is set, another x-ray is taken for control. When the best result is achieved, a special bandage (most often plaster) is applied so that the bone begins to heal.

Bone repositioning can be one-stage or consist of several stages. The connection of fragments is done manually by our traumatologist or using a modern device.

• Open reduction

With open reduction, anesthesia is first given, and then the doctor finds access to the fracture. The fracture site must be exposed. When using special bone holders, reduction is performed. When the bone is collected and there are no displaced fragments, it is fixed with metal holders. Open reduction is a major surgical procedure.

• Closed reduction

To perform a closed reduction, there is no need to expose the bone, because the skin remains intact. The limb is realigned using various techniques. Our traumatologists have extensive experience in immediate and gradual reduction techniques.

The manipulations are practically painless for the patient, as they are performed under local or general anesthesia.

Why is it important to choose professionals?

An amateur may incorrectly assemble bone fragments, causing the limb to function improperly and have limited capabilities. In such cases, everything will have to be redone, and this is much worse for the patient (stress and complications). With open reduction, unqualified personnel can introduce infection inside, which will aggravate an already serious condition.

Contact the Osnova clinic - professionals

In our clinic you can receive not only emergency care, but also recommendations for recovery during the rehabilitation period. The doctor constantly monitors the condition of his patient during treatment. If you are unable to come, call us and we will deliver the patient to the clinic for tests (X-rays) and an urgent examination by a traumatologist. You will be seen by a qualified traumatologist, orthopedist, and will help you solve the most difficult issues.

Preparation, diagnostics

Although the reduction of the bones of the nasal skeleton is an outpatient procedure, it is necessary to prepare for it in advance. Diagnostic measures are aimed at clarifying the nature, type and degree of the fracture, as well as identifying other disorders. Preoperative preparation includes:

• X-ray of the nose and paranasal sinuses;
• rhinoscopy;
• CT, MRI of the skull;
• blood and urine tests;
• consultation with an anesthesiologist.

The procedure is carried out in the first few hours after the injury, before tissue swelling occurs, or after 2-5 days, when the swelling subsides.
If more than 10 days have passed after the injury, it will be much more difficult to realign the nose, and after 3 weeks a callus will begin to form at the fracture site and repositioning can only be done with a complex operation. Therefore, it is extremely important to seek qualified help in a timely manner. An experienced surgeon will perform the procedure according to indications quickly and with minimal discomfort. After a short time, nothing will remind you of the trauma you suffered.