What are Open and Closed Reductions?
Reduction is a medical procedure performed to repair and fix a fracture or dislocation.
Open reduction (OR) involves fixing the fracture fragments or dislocation with open surgery by dissecting the tissues.
Closed reduction (CR) is manipulating and fixing the fracture fragments or dislocations into alignment externally without surgery.
In both cases, the aim is to realign the broken bone pieces or the dislocation into the normal anatomical position. The choice of OR or CR depends on the severity of the fracture and other variables.
Indications for the Procedure
Open reduction is mostly followed in cases such as:
- Multiple or serious bone fractures or severe breaks
- Bone displacement or disruption of articular joint surfaces
- Failure of previously performed closed reduction
- Abnormal healing (deformity) or non-healing after the initial treatment
- A fracture at an unstable joint
- A fracture with bone sticking out through the skin
- A fracture or dislocation that cannot be treated with a cast, splint or brace
Closed reduction is usually performed if the fracture or dislocation is minor and can be treated with a cast or splint.
Preparation
Regardless of the type of reduction, your surgeon will:
- Evaluate your medical history
- Perform a physical examination
- Order specific blood tests
Imaging tests such as X-ray, CT scan or MRI will also be ordered to view and examine the exact point of fracture or dislocation.
In cases of open reduction, you will be advised to:
- Discontinue any medications you are taking a week before the surgery
- Not to eat anything after midnight on the day before the procedure
- Arrange someone to drive you back home after the surgery
The Procedure
Treating a fracture or a dislocation aptly is crucial to make sure the bone fixes and heals properly, and permanent functional loss or deformity is avoided.
Open reduction
Every open reduction surgery differs and is based on the type and location of the fracture. Just before the procedure, you will be given general anesthesia and put on a breathing tube to help you breathe properly.
During the procedure:
- The skin on the affected part is washed with an antiseptic.
- An incision is made and the affected part is accessed.
- Fractured or dislocated bones are realigned into their normal position.
- Realigned bones are held together with rods, screws, plates or pins.
- The incision is closed with stitches or staples. A bandage or dressing is applied.
- A cast or splint is placed depending on the location and type of fracture.
The procedure may take several hours depending on the extent of the fracture or dislocation. Recovery usually takes around 3 to 12 months and depends mainly on:
- The type, severity, and location of the fracture
- Age and health condition of the patient
- Post-surgery rehabilitation process
Closed reduction
Closed reduction can work best when performed soon after the fracture or dislocation. The procedure is performed externally and does not involve cutting the skin open and exposing the affected part.
Closed reduction can often be very painful to undergo. Therefore, you will be administered any of the following to minimize or block the pain during the procedure.
- A nerve block or local anesthetic to numb the affected area
- Sedative to make you relax, but not fall asleep
- General anesthesia to make you sleep
Once the medicine is delivered, your surgeon will perform a technique called “traction”, wherein the bone pieces will be aligned in the right position by pushing or pulling using their hands. Occasionally, specialized instruments may be used to adjust or realign the bone pieces.
Following the traction:
- An x-ray is taken to make sure the bone pieces are in the correct position.
- A cast or a splint is placed to hold the bone pieces in position while healing.
Recovery can take anywhere from 8 to 12 weeks and depends on the patient’s age, type of bone and break, and general health of the patient.
Risks or Complications
Open reduction
- Bleeding
- Bacterial infection
- Reaction to anesthesia
- Blood clot
- Bone setting failure
- Muscle damage
- Nerve or blood vessel damage,
- Arthritis
- Tendon or ligament damage
- Loss of range of motion or deformity
- Chronic pain due to hardware
- Audible snapping and popping
Closed reduction
- Injury to nerves or blood vessels near the treated bone fracture
- Blood clot that could travel to the lungs or other parts
- Allergic reaction to the pain medicine administered
- New fractures and re-surgery (especially open reduction)
- Bone setting failure
- Muscle damage
- Incomplete or abnormal bone healing
After Reduction Care
Open reduction
- Limit movement of the area until the bone becomes solid enough for normal activity.
- Keep the area around the incision clean and pressure free until the wound heals.
Closed reduction
- Rest the treated part as much as possible and keep it raised above the heart level to reduce swelling.
It is important to attend all your checkups after the reduction and take pain medications as instructed. This will let your surgeon monitor your healing process and help ensure a quick and successful recovery.
Benefits of the Procedure
Open reduction
- Helps restore mobility by helping the bone heal in the correct position
- Removes the pain completely in most cases and prevents deformity
- Allows an early range of motion therapy and helps the patient to recover faster
Closed reduction
- Helps the bone heal fast and be strong when it heals
- Avoids surgery and complications associated with it
- Lowers the risk of an infection in the bone
- Reduces swelling and removes tension on the skin