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Manual traction

Reduction techniques

There are, in general, two basic methods to reduce the metaphyseal/diaphyseal component of a distal femur fracture when utilizing a blade plate. The method utilized depends on the fracture morphology. In the first method, the fracture of the metaphysis undergoes a direct reduction and then the blade plate is subsequently inserted. This might be done in a single plane short spiral or oblique fractures.
In the second method, the blade plate is inserted into the correct position in the distal articular block of the femur. Then, after manual traction is used to restore the appropriate length and rotation, the bone is drawn down to the plate and the proximal screws are inserted. This type of reduction is very helpful in highly comminuted metaphyseal/diaphyseal fractures.

Direct reduction instruments include:

  • Large pointed reduction forceps
  • Bone repositioning forceps
  • Bone hook

Indirect reduction techniques are:

  • Manual traction (illustrated)
  • External fixator/distractor

Pitfall: osteoporotic bone
In osteoporotic bone indirect reduction techniques, using the angled blade plate itself, may be preferable as attempts to reduce the fracture directly may cause severe comminution. Attempts to apply reduction clamps to osteoporotic bone will potentially crush the bone.