Fracture Reduction

Fracture reduction is a medical procedure that realigns broken bone fragments back into their correct position so the bone can heal properly.

When a bone breaks, the two or more fragments often shift out of place. Left in that position, the bone may heal crookedly, causing long-term pain or loss of movement. During fracture reduction, the doctor maneuvers the fragments back into alignment. This can be done by hand through the skin — called closed reduction — or through a surgical incision (a cut in the skin) that allows the doctor to see and fix the bone directly, called open reduction. Once aligned, the bone is usually held in place with a cast, splint, or internal hardware such as metal plates, screws, or rods.

Fracture reduction is used whenever a broken bone has shifted out of its normal position and cannot be expected to heal correctly on its own. The goal is always to restore the bone's shape and the joint's function as closely as possible to what they were before the injury.

• Displaced fractures — breaks where the bone ends have moved apart or overlapped
• Comminuted fractures — breaks where the bone has shattered into several pieces
• Intra-articular fractures — breaks that extend into a joint (such as the knee, ankle, or wrist)
• Open fractures — breaks where bone has pierced through the skin
• Growth-plate fractures in children, where correct alignment is important for normal bone development
• Fractures of the forearm, wrist, ankle, femur (thigh bone), tibia (shin bone), or hip that are unstable or significantly displaced
• Fractures that did not heal correctly the first time (malunion or non-union)

Not every broken bone requires reduction. Some fractures are not suitable for this procedure, particularly when:

• The bone fragments are still well aligned (a non-displaced fracture) — simple immobilization is enough
• The patient's overall health makes surgery too dangerous
• Severe infection at the fracture site makes open surgery high-risk until the infection is treated
• Blood supply to the area is so poor that healing after surgery is unlikely

Like any procedure involving bone and tissue, fracture reduction carries recognised risks, which vary depending on whether it is done as a closed (non-surgical) or open (surgical) procedure, the location of the fracture, and the patient's general health.

• Pain and swelling around the fracture site during and after the procedure
• Skin irritation or pressure sores under a cast or splint
• Incomplete reduction — the bone does not return fully to its ideal position and may need a second attempt
• Re-displacement — the bone shifts again before it has fully healed
• Infection, especially with open fractures or after surgical open reduction
• Nerve injury (damage to nearby nerves), causing numbness, tingling, or weakness
• Blood vessel injury, which may affect blood supply to the limb
• Compartment syndrome — a serious build-up of pressure inside the muscle compartment that requires urgent treatment
• Deep vein thrombosis (DVT) — blood clots forming in a vein, more common when a limb is immobilised for a long period
• Delayed healing, malunion (bone heals in a poor position), or non-union (bone fails to heal)
• Reactions to anaesthesia (the medication used to reduce pain or cause sleep during the procedure)
• Scarring at the incision site after open reduction

Preparation depends on whether the procedure will be done under local anaesthesia (numbing only the injured area), regional anaesthesia (numbing a larger section of the body), or general anaesthesia (putting the patient fully to sleep). Your care team will explain which type is planned for your situation.

Before the procedure, patients are typically asked to:

• Avoid eating or drinking for a set number of hours if general or regional anaesthesia is planned — the exact duration will be specified by the anaesthetist (the doctor who manages anaesthesia)
• Inform the team about all medications currently taken, including blood thinners, anti-inflammatory drugs (medications that reduce swelling), and supplements, as some may need to be paused
• Stop smoking in the period leading up to surgery if possible, as smoking slows bone healing and increases infection risk
• Limit or avoid alcohol in the days before the procedure
• Arrange transport home and, for surgical cases, plan for someone to assist at home in the early recovery period

Tests that are usually ordered beforehand include:

• X-ray — to confirm the fracture pattern and degree of displacement
• CT scan (computed tomography) — for complex fractures, especially those near joints, to map the exact position of all fragments
• Blood tests — to check general health, clotting ability, and whether the patient is fit for anaesthesia
• EKG (electrocardiogram) and chest X-ray — may be requested for older patients or those with heart or lung conditions

During the procedure itself, the typical sequence of steps is as follows, though the exact process varies by fracture type and whether the approach is closed or open:

• 1. The patient is positioned on the procedure table and monitoring equipment is attached.
• 2. Anaesthesia is given — local, regional, or general depending on what was planned.
• 3. For closed reduction: the doctor applies controlled force and traction (a steady pulling motion) to guide the bone fragments back into alignment through the skin, without any incision.
• 4. For open reduction: the surgeon makes an incision over the fracture site, directly visualises the bone, and manually repositions the fragments.
• 5. Internal fixation devices (implants) such as metal plates, screws, intramedullary nails (rods placed inside the bone canal), or wires may be inserted to hold the fragments in place.
• 6. The position of the bone is confirmed with intraoperative X-ray or fluoroscopy (a live X-ray image on a screen).
• 7. For open reduction, the incision is closed with stitches or staples and a sterile dressing is applied.
• 8. A cast, splint, or external fixator (a frame outside the skin connected to pins in the bone) is applied if needed to provide additional stability.

Recovery after fracture reduction varies widely depending on which bone was treated, the severity of the fracture, the patient's age and overall health, and whether the procedure was closed or open. Your orthopaedic team will give you a personalised recovery plan.

• Monitoring: after closed reduction, patients may go home the same day once pain is controlled and circulation in the limb is confirmed normal. After open reduction and fixation, a hospital stay of at least one to several days is usual, with nurses checking for signs of infection, swelling, or circulation problems.
• Pain management: the care team will typically manage pain with appropriate medications in the initial days; patients are advised not to adjust pain medication on their own.
• Elevation: keeping the injured limb raised above heart level in the early days helps reduce swelling.
• Cast or splint care: patients are advised not to get a cast wet, not to push objects inside to scratch under it, and to watch for increasing tightness, numbness, or colour changes in the fingers or toes — all of which should be reported immediately.
• Weight-bearing restrictions: the doctor will specify whether the limb can bear weight and when — this varies greatly by fracture site and type of fixation. Many patients need crutches, a walking frame, or a wheelchair for a period.
• Wound care (for open reduction): the incision site should be kept clean and dry according to the surgeon's instructions until stitches or staples are removed.
• Physiotherapy (physical rehabilitation): exercises to restore strength and range of motion are usually started once the bone has reached a safe stage of healing. The timing is decided by the surgeon.
• Follow-up imaging: repeat X-rays are taken at regular intervals to confirm the bone is healing in the correct position.
• Hardware removal: in some cases, metal implants are removed in a second, smaller procedure after the bone has fully healed — your surgeon will advise whether this applies to you.
• Lifestyle: smoking should be avoided throughout the healing period as it significantly slows bone repair. A diet adequate in calcium and vitamin D supports bone healing.
• Warning signs to report promptly: increasing pain, fever, redness or discharge at the wound site, new numbness or weakness in the limb, or the cast feeling suddenly loose or cracked.