Reduction is an essential part of intramedullary nailing. The fracture must be reduced to allow guide-wire placement, during reaming, and during nail insertion. Length, angulation, and rotation are all important to restore. Even after guide-wire insertion, further correction of alignment may be needed to avoid deformity. This should be done before reaming and nail insertion.
Reduction is usually more challenging with proximal and distal fractures as well as with delayed treatment. Sometimes only mild traction and rotational adjustment are required. Percutaneous reduction aids (pointed reduction forceps, Schanz screws or ball-spike pusher) may allow reduction without opening the fracture. With other fractures, open reduction may be necessary.
Unless the fracture is older and consolidated, the surgeon usually begins with less invasive reduction techniques, and if they do not succeed, progresses to techniques which require more fracture exposure .
The following illustrations of the different reduction techniques provide examples that can be used or modified as necessary.