Reduction by external fixator or distractor
Sometimes, manual traction is not sufficient to achieve and hold preliminary reduction.
If manual traction is not sufficient, the use of an external fixator can facilitate the reduction procedure and can provide temporary alignment and stability for the bridge plating procedure.
Proximal and distal fixator screws should be inserted carefully in order not to conflict with the later plating procedure. For this purpose, safe positions would be anterolateral or anterior on the femur.
If no traction table is used, folded linen bolsters under the fracture zone may facilitate the reduction maneuver.