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When fixing the bone plate, the reduction technique is a key link to ensure good fracture healing and restore limb function. The following is a detailed introduction to the reduction techniques during bone plate fixation:
Preparations before resetting
Comprehensive assessment: Before the operation, through imaging examinations (such as X-rays, CT scans, etc.), the type of fracture, the direction and degree of displacement, as well as the injury of the surrounding soft tissues, are determined, and a personalized reduction and fixation plan is formulated. For example, for comminuted fractures, it is necessary to understand the number, size and location of the fracture fragments so as to take targeted measures during reduction.
Select an appropriate position: Based on the fracture site and surgical method, choose an appropriate position that not only facilitates the surgical operation but also minimizes adverse effects on the patient’s body. For example, when performing bone plate fixation for lower extremity fractures, patients usually lie in the supine position and appropriately elevate the affected limb to facilitate reduction and fixation.
Prepare the reduction tools: Get all kinds of reduction tools ready, such as periosteal removers, reduction pliers, bone holders, etc., and ensure they are in good performance and flexible to use. Different reduction tools are suitable for different types of fractures. Doctors should choose the appropriate tool based on the specific situation.
Key points of reset techniques
Indirect reduction is the main method: For the majority of fractures, especially intra-articular fractures and those with poor surrounding soft tissue conditions, indirect reduction techniques should be given priority. Through techniques such as traction, rotation, and angulation, the pulling effect of the muscles and the natural mating tendency of the fracture ends are utilized to achieve or approach anatomical reduction of the fracture ends. For instance, in the reduction of femoral shaft fractures, continuous longitudinal traction can be used to utilize the contractile force of the quadriceps femoris and hamstrings to gradually reduce the fracture ends.
Precise manual reduction: When indirect reduction fails to achieve the desired effect, manual reduction can be adopted. Doctors should be proficient in various reduction techniques, such as lifting, pressing, and pushing. The movements should be gentle and accurate to avoid further damage to the fracture end caused by excessive force. For example, for distal radius fractures, the distal flexion end can be pushed and squeezed towards the palmar and radial sides through manual manipulation to restore the normal anatomical relationship of the wrist joint.
The use of special instruments for assistance: The use of special instruments such as bone hooks and bone skids to assist in reduction can more precisely control the position of the fracture fragments. For instance, in the reduction of calcaneal fractures, a bone hook can be used to hook the calcaneal tubercle. Through traction and prying, the shortening, widening and inversion deformities of the calcaneus can be corrected.
Pay close attention to the alignment and alignment of the fracture ends: During the reduction process, closely monitor the alignment and alignment of the fracture ends to ensure that the fracture achieves functional reduction or anatomical reduction. Functional reduction requires that the rotation and separation displacement of the fracture ends be completely corrected. Angular displacement perpendicular to the direction of joint movement should be completely corrected. For those consistent with the direction of joint movement, it should not exceed 10° for adults and 15° for children. The length of limbs shortens. For adults, it should be shortened by no more than 1cm, while for children, due to bone growth and development, it can be shortened by no more than 2cm. Anatomical reduction requires that the fracture ends restore the normal anatomical relationship and the alignment be completely good.
Temporary fixation to maintain reduction: After reduction, it is necessary to promptly use Kirschner’s needles, Slinger’s needles, etc. for temporary fixation to maintain the reduction state of the fracture end and prevent displacement during the placement of the bone plate and the tightening of screws. The position and quantity of temporary fixation should be determined based on the stability of the fracture and the surgical requirements.
Combined with the characteristics of bone plate fixation
Consider the shape and length of the bone plate: Select a bone plate of an appropriate shape and length to ensure a good fit with the bone surface at the fracture site. During reduction, the reduction state of the fracture end should be adjusted according to the shape of the bone plate and the expected fixation position. For example, for fractures of the proximal femur, a proximal femur locking plate with a specific anatomical shape should be selected. During reduction, the fracture end should match the shape of the plate.
Final reduction using a bone plate: During the placement of the bone plate, it can be used as a reduction tool to further adjust and fix the fracture ends. By temporarily fixing the bone plate at one end of the fracture and then pulling or pushing the fracture fragment at the other end to make it closely adhere to the bone plate, the final reduction effect is achieved.
Pay attention to the sequence and position of screw fixation: The sequence and position of screwing in screws can also affect the reduction and fixation effect of fractures. Generally speaking, one side of the fracture end should be fixed first, followed by the other side to maintain the stability of the fracture end. At the same time, attention should be paid to the insertion point and direction of the screws to prevent them from penetrating the cortical bone or damaging important structures such as blood vessels and nerves around.
Postoperative assessment and adjustment
Imaging examination assessment: X-ray, CT and other imaging examinations should be conducted immediately after the operation to evaluate the reduction and fixation of the fracture. If it is found that the reset is not ideal or the fixation is unstable, corresponding measures should be taken in time for adjustment.
Closely monitor the patient’s condition: After the operation, closely observe the patient’s vital signs, wound condition, and limb sensation and motor functions, etc. If any abnormal conditions occur, such as limb swelling, increased pain, or abnormal sensations, they should be dealt with promptly. If necessary, repositioning and fixation should be performed.