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Reduction principles

The key to all fracture reduction is restoring axial length.
Ways of gaining length are:

  • Manual traction (only for simpler fresh fractures)
  • Distractor or external fixator
  • Use of reduction forceps
  • Push-pull screws
  • Articulated tension device (ATD).

If any shortening is present, distraction should be applied and maintained before fracture consolidation occurs. Otherwise, callus and vascular soft tissues will need to be released from bone fragments to permit reduction. This may require provisional external fixation. Even if delay before reduction and fixation is short, progressive intraoperative lengthening is easier and less traumatic if aids for distraction are routinely employed.