Current concepts in fracture reduction
04. November 2002
Accepted 04. November 2002
22. Februar 2018 (online)
Fracture management includes preoperative planning, implant selection, fracture reduction, implant application, and postoperative patient management. Fracture reduction can be one of the most challenging parts of the process. Time honoured principles, of gradual progressive traction and counter-traction, to anatomically restore the bone contour are still effective methods of fracture reduction (2). However, new concepts have emerged that incorporate: balanced anaesthesia techniques, image guided minimally invasive implant placement, bone alignment (rather than anatomical reconstruction) for comminuted fractures, and additional methods of achieving mechanical leverage (1, 3, 4, 16). The purpose of this paper is to discuss the decision making process for selecting fracture reduction techniques; and to describe those techniques for achieving and maintaining reduction for specific fractures.
- 1 Aron DN, Palmer RH, Johnson AL. Biologic strategies and a balanced concept for repair of highly comminuted long bone fractures. Compend Cont Educ Small Anim 1995; 17: 35-49.
- 2 Brinker WO. Suggestions for the reduction of fractures. Vet Comp Orthop Traumatol 1990; 01: 20-6.
- 3 Cook JL, Tomlinson JL, Reed AL. Fluoroscopically guided closed reduction and internal fixation of fractures of the lateral portion of the humeral condyle: Prospective clinical study of the technique and results in ten dogs. Vet Surg 1999; 28: 315-321.
- 4 Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orhop Trauma Surg 1990; 109: 295-303.
- 5 Hendrix PK, Raffe MR, Robinson EP, Felice LJ, Randall DA. Epidural administration of bupivacaine, morphine or their combination for postoperative analgesia in dogs. J Am Vet Med Assoc 1996; 209: 598-607.
- 6 Hulse D, Hyman W, Nori M, Slater M. Reduction in plate strain by addition of an intramedullary pin. Vet Surg 1997; 26: 451-9.
- 7 Johnson AL, Hulse DA. Fracture Reduction. In Small Animal Surgery. 2nd Edition. Fossum TW. Editor. Mosby Yearbook Inc; 2002: 889-93.
- 8 Johnson AL, Seitz SE, Smith CW, Johnson JM, Schaeffer DJ. Closed reduction and type-II external fixation of severely comminuted fractures of the radius and tibia in dogs: 23 cases (1990-1994). J Am Vet Med Assoc 1996; 209: 1445-8.
- 9 Johnson AL, Smith CW, Schaeffer DL. Fragment reconstruction and bone plate fixation versus bridging plate fixation for treating highly comminuted femoral fractures in dogs: 35 cases (1987-1997). J Am Vet Med Assoc 1998; 203: 1157-61.
- 10 Kraus KH, Wooton HM, Boudrieau RJ, Schwarz L. et al. Type-II external fixation, using new clamps and positive-profile threaded pins, for treatment of fractures of the radius and tibia in dogs. J Am Vet Med Assoc 1998; 212: 1267-70.
- 11 Perren SM. The concept of biological plating using the limited contact dynamic compression plate (LC-DCP). Injury 1992; 22 (Suppl. 01) 1-40.
- 12 Roe SC, Johnson AL, Harari J. A technique for multiple transfixation pins in applying bilateral external fixators. Vet Surg 1985; 14: 247-52.
- 13 Roe SC, Johnson KA. Use of an aiming device for application of a type-II (bilateral) external fixator to a fractured tibia of a dog. J Am Vet Med Assoc 1988; 192: 1573-6.
- 14 Rozbruch SR, Mueller U, Gautier E, Ganz R. The evolution of femoral shaft plating technique. Clin Ortho Rel Res 1998; 354: 195-208.
- 15 Tomlinson JL, Cook JL, Payne JT, Anderson CC, Johnson JC. Closed reduction and lag screw fixation of sacroiliac luxations and fractures. Vet Surg 1999; 28: 188-193.
- 16 Tranquilli WJ, Grimm KA, Lamont LA. Pain management for the small animal practitioner. Teton NewMedia; Jackson WY: 2000